- 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
- $759.16 / $1,164.57 / $3,327.51
| Professional | | $759.16 | $1,164.57 | $3,327.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.11 / $2,297.14 / $7,896.02
| Facility | | $1,264.11 | $2,297.14 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.47 / $2,344.57 / $2,961.89
| Facility | | $1,479.47 | $2,344.57 | $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 |