- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.92 / $1,514.40 / $3,155.37
| Professional | | $945.92 | $1,514.40 | $3,155.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,585.01 / $2,470.21 / $6,034.22
| Facility | | $1,585.01 | $2,470.21 | $6,034.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.85 / $2,243.79 / $2,824.47
| Facility | | $1,802.85 | $2,243.79 | $2,824.47 |
- 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 |