- 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
- $695.85 / $1,101.15 / $2,225.32
| Professional | | $695.85 | $1,101.15 | $2,225.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.15 / $1,898.47 / $11,139.12
| Facility | | $1,149.15 | $1,898.47 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.00 / $1,914.06 / $6,616.19
| Facility | | $1,335.00 | $1,914.06 | $6,616.19 |
- 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 |