- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $7,943.37
| Facility | | $4,693.00 | $5,549.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.89 / $828.56 / $2,007.36
| Professional | | $520.89 | $828.56 | $2,007.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.88 / $1,392.00 / $7,896.02
| Facility | | $850.88 | $1,392.00 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.00 / $1,486.33 / $2,961.89
| Facility | | $1,060.00 | $1,486.33 | $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 |