- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,235.76 / $5,152.00 / $7,943.37
| Facility | | $2,235.76 | $5,152.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.77 / $1,052.48 / $2,069.59
| Professional | | $688.77 | $1,052.48 | $2,069.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.39 / $1,769.95 / $7,123.00
| Facility | | $700.39 | $1,769.95 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.67 / $1,835.59 / $2,961.89
| Facility | | $1,125.67 | $1,835.59 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |