- 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
- $616.92 / $1,023.22 / $2,133.15
| Professional | | $616.92 | $1,023.22 | $2,133.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.40 / $1,641.62 / $11,139.12
| Facility | | $1,046.40 | $1,641.62 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.02 / $1,641.62 / $6,616.19
| Facility | | $1,229.02 | $1,641.62 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |