- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $5,091.00 / $7,119.04
| Facility | | $3,468.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.63 / $955.46 / $2,327.80
| Professional | | $605.63 | $955.46 | $2,327.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.99 / $1,641.02 / $6,267.00
| Facility | | $1,084.99 | $1,641.02 | $6,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,188.00 / $1,683.50 / $2,961.89
| Facility | | $1,188.00 | $1,683.50 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |