- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.93 / $1,221.52 / $3,249.39
| Professional | | $880.93 | $1,221.52 | $3,249.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.27 / $2,183.89 / $6,034.22
| Facility | | $881.27 | $2,183.89 | $6,034.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.81 / $2,100.42 / $2,517.60
| Facility | | $1,472.81 | $2,100.42 | $2,517.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |