- 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
- $724.29 / $1,118.88 / $2,653.53
| Professional | | $724.29 | $1,118.88 | $2,653.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.41 / $1,873.56 / $4,873.45
| Facility | | $1,199.41 | $1,873.56 | $4,873.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,698.68 / $2,020.28
| Facility | | $1,285.00 | $1,698.68 | $2,020.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |