- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.01 / $1,891.86 / $3,815.13
| Professional | | $1,115.01 | $1,891.86 | $3,815.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.52 / $2,785.40 / $5,497.82
| Facility | | $1,557.52 | $2,785.40 | $5,497.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.64 / $1,986.54 / $3,260.69
| Facility | | $1,471.64 | $1,986.54 | $3,260.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |