- 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
- $782.34 / $1,191.67 / $2,725.03
| Professional | | $782.34 | $1,191.67 | $2,725.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.30 / $2,106.31 / $14,242.22
| Facility | | $1,341.30 | $2,106.31 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.00 / $2,106.31 / $8,656.83
| Facility | | $1,335.00 | $2,106.31 | $8,656.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |