- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.44 / $1,011.64 / $2,232.46
| Professional | | $595.44 | $1,011.64 | $2,232.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.14 / $1,585.01 / $11,139.12
| Facility | | $1,011.14 | $1,585.01 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.84 / $1,585.01 / $6,616.19
| Facility | | $1,186.84 | $1,585.01 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $9,495.24 / $18,346.22
| Facility | | $5,341.00 | $9,495.24 | $18,346.22 |