- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.28 / $4,604.83 / $8,042.03
| Facility | | $3,204.28 | $4,604.83 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.57 / $1,178.54 / $2,028.64
| Professional | | $680.57 | $1,178.54 | $2,028.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.81 / $1,867.54 / $6,267.00
| Facility | | $966.81 | $1,867.54 | $6,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.00 / $1,935.06 / $2,429.98
| Facility | | $1,330.00 | $1,935.06 | $2,429.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,396.00 / $5,163.00 / $7,350.19
| Facility | | $3,396.00 | $5,163.00 | $7,350.19 |