- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $8,300.34
| Facility | | $4,146.00 | $5,091.00 | $8,300.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.69 / $988.25 / $2,538.33
| Professional | | $585.69 | $988.25 | $2,538.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.85 / $1,542.51 / $7,896.02
| Facility | | $970.85 | $1,542.51 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.00 / $1,553.00 / $2,961.89
| Facility | | $1,199.00 | $1,553.00 | $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 |