- 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
- $610.01 / $962.46 / $2,370.17
| Professional | | $610.01 | $962.46 | $2,370.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.85 / $1,576.02 / $4,645.00
| Facility | | $1,092.85 | $1,576.02 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.00 / $1,489.90 / $1,897.54
| Facility | | $1,191.00 | $1,489.90 | $1,897.54 |
- 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 |