- 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
- $664.22 / $1,057.23 / $2,278.81
| Professional | | $664.22 | $1,057.23 | $2,278.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.84 / $1,756.63 / $7,896.02
| Facility | | $1,047.84 | $1,756.63 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.00 / $1,763.67 / $2,961.89
| Facility | | $1,315.00 | $1,763.67 | $2,961.89 |
- 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 |