- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $4,964.00 / $9,185.68
| Facility | | $4,146.00 | $4,964.00 | $9,185.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.73 / $1,687.87 / $2,814.41
| Professional | | $971.73 | $1,687.87 | $2,814.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.06 / $2,716.26 / $13,960.05
| Facility | | $1,516.06 | $2,716.26 | $13,960.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.31 / $2,337.80 / $3,057.68
| Facility | | $1,554.31 | $2,337.80 | $3,057.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |