- 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
- $703.45 / $1,111.88 / $2,644.26
| Professional | | $703.45 | $1,111.88 | $2,644.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.68 / $1,930.67 / $7,896.02
| Facility | | $1,253.68 | $1,930.67 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,402.00 / $1,932.62 / $2,961.89
| Facility | | $1,402.00 | $1,932.62 | $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 |