- 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
- $640.16 / $1,019.69 / $2,314.56
| Professional | | $640.16 | $1,019.69 | $2,314.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.57 / $1,651.94 / $11,139.12
| Facility | | $1,039.57 | $1,651.94 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.00 / $1,651.94 / $6,616.19
| Facility | | $1,274.00 | $1,651.94 | $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 |