- 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
- $608.61 / $949.77 / $2,303.73
| Professional | | $608.61 | $949.77 | $2,303.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.98 / $1,645.29 / $7,896.02
| Facility | | $1,008.98 | $1,645.29 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.00 / $1,656.59 / $2,961.89
| Facility | | $1,246.00 | $1,656.59 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $7,091.00 / $9,874.90
| Facility | | $4,700.00 | $7,091.00 | $9,874.90 |