- 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
- $709.12 / $1,097.73 / $2,785.94
| Professional | | $709.12 | $1,097.73 | $2,785.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.66 / $1,900.57 / $11,139.12
| Facility | | $1,171.66 | $1,900.57 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.08 / $1,834.26 / $6,616.19
| Facility | | $1,374.08 | $1,834.26 | $6,616.19 |
- 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 |