- 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
- $630.97 / $1,006.07 / $2,162.28
| Professional | | $630.97 | $1,006.07 | $2,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.59 / $1,658.04 / $4,873.45
| Facility | | $1,045.59 | $1,658.04 | $4,873.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.20 / $1,519.63 / $1,969.98
| Facility | | $1,249.20 | $1,519.63 | $1,969.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |