- 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
- $848.69 / $1,485.71 / $2,342.53
| Professional | | $848.69 | $1,485.71 | $2,342.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.80 / $2,084.29 / $3,984.48
| Facility | | $1,208.80 | $2,084.29 | $3,984.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.65 / $1,908.40 / $2,675.95
| Facility | | $1,349.65 | $1,908.40 | $2,675.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |