- 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
- $983.18 / $1,508.40 / $3,420.47
| Professional | | $983.18 | $1,508.40 | $3,420.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.33 / $2,423.53 / $6,608.00
| Facility | | $1,297.33 | $2,423.53 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.28 / $2,256.42 / $2,896.58
| Facility | | $1,909.28 | $2,256.42 | $2,896.58 |
- 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 |