- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $9,185.68
| Facility | | $4,146.00 | $5,091.00 | $9,185.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.86 / $1,014.30 / $1,965.36
| Professional | | $575.86 | $1,014.30 | $1,965.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.06 / $1,529.55 / $10,188.00
| Facility | | $905.06 | $1,529.55 | $10,188.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.35 / $1,678.30 / $7,050.50
| Facility | | $1,247.35 | $1,678.30 | $7,050.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |