- 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
- $664.28 / $1,049.97 / $2,247.03
| Professional | | $664.28 | $1,049.97 | $2,247.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.28 / $1,828.32 / $7,896.02
| Facility | | $1,159.28 | $1,828.32 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.00 / $1,833.75 / $2,961.89
| Facility | | $1,309.00 | $1,833.75 | $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 |