- 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
- $843.99 / $1,433.29 / $3,316.92
| Professional | | $843.99 | $1,433.29 | $3,316.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.15 / $2,220.94 / $12,257.52
| Facility | | $1,424.15 | $2,220.94 | $12,257.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.30 / $2,055.98 / $2,689.06
| Facility | | $1,660.30 | $2,055.98 | $2,689.06 |
- 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 |