- 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
- $689.47 / $1,092.02 / $2,290.71
| Professional | | $689.47 | $1,092.02 | $2,290.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.48 / $1,873.19 / $7,896.02
| Facility | | $1,080.48 | $1,873.19 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.00 / $1,878.51 / $2,961.89
| Facility | | $1,316.00 | $1,878.51 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $7,091.00 / $9,874.90
| Facility | | $4,700.00 | $7,091.00 | $9,874.90 |