- 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
- $671.33 / $1,030.22 / $3,616.17
| Professional | | $671.33 | $1,030.22 | $3,616.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.34 / $1,826.10 / $7,896.02
| Facility | | $1,110.34 | $1,826.10 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.78 / $1,839.49 / $2,961.89
| Facility | | $1,304.78 | $1,839.49 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |