- 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
- $1,228.16 / $1,912.94 / $4,601.85
| Professional | | $1,228.16 | $1,912.94 | $4,601.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,544.71 / $2,950.00 / $6,608.00
| Facility | | $1,544.71 | $2,950.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.85 / $2,482.62 / $3,494.13
| Facility | | $1,802.85 | $2,482.62 | $3,494.13 |
- 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 |