- 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
- $533.16 / $842.27 / $2,190.09
| Professional | | $533.16 | $842.27 | $2,190.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.37 / $1,417.59 / $7,896.02
| Facility | | $828.37 | $1,417.59 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.35 / $1,422.88 / $2,961.89
| Facility | | $1,068.35 | $1,422.88 | $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 |