- 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
- $659.68 / $1,034.78 / $1,773.34
| Professional | | $659.68 | $1,034.78 | $1,773.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.26 / $1,836.58 / $6,034.22
| Facility | | $1,123.26 | $1,836.58 | $6,034.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.57 / $1,765.22 / $2,256.42
| Facility | | $1,316.57 | $1,765.22 | $2,256.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |