- 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
- $660.43 / $1,043.84 / $2,517.15
| Professional | | $660.43 | $1,043.84 | $2,517.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.61 / $1,804.20 / $7,896.02
| Facility | | $1,090.61 | $1,804.20 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,816.79 / $3,593.78
| Facility | | $1,285.00 | $1,816.79 | $3,593.78 |
- 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 |