- 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
- $723.57 / $1,145.21 / $2,372.82
| Professional | | $723.57 | $1,145.21 | $2,372.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.29 / $1,966.58 / $7,896.02
| Facility | | $1,195.29 | $1,966.58 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,974.39 / $2,961.89
| Facility | | $1,400.00 | $1,974.39 | $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 |