- 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
- $650.99 / $1,029.21 / $2,240.41
| Professional | | $650.99 | $1,029.21 | $2,240.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.98 / $1,776.76 / $6,267.00
| Facility | | $1,066.98 | $1,776.76 | $6,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,785.50 / $3,584.47
| Facility | | $1,285.00 | $1,785.50 | $3,584.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |