- 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
- $742.51 / $1,184.13 / $2,710.47
| Professional | | $742.51 | $1,184.13 | $2,710.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.39 / $1,783.10 / $2,962.51
| Facility | | $1,124.39 | $1,783.10 | $2,962.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,719.96 / $2,128.94
| Facility | | $1,257.44 | $1,719.96 | $2,128.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,775.00 / $3,560.25
| Facility | | $1,151.00 | $1,775.00 | $3,560.25 |