- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $10,613.08
| Facility | | $3,496.00 | $5,091.00 | $10,613.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.30 / $895.71 / $2,033.84
| Professional | | $563.30 | $895.71 | $2,033.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.14 / $1,483.24 / $12,342.67
| Facility | | $844.14 | $1,483.24 | $12,342.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.07 / $1,483.24 / $6,616.19
| Facility | | $1,112.07 | $1,483.24 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |