- 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
- $682.76 / $1,066.16 / $2,292.05
| Professional | | $682.76 | $1,066.16 | $2,292.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.74 / $1,798.46 / $14,242.22
| Facility | | $1,091.74 | $1,798.46 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.02 / $1,791.80 / $6,616.19
| Facility | | $1,341.02 | $1,791.80 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $11,555.00 / $18,346.22
| Facility | | $8,220.00 | $11,555.00 | $18,346.22 |