- 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
- $924.46 / $1,504.50 / $3,612.27
| Professional | | $924.46 | $1,504.50 | $3,612.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.67 / $2,469.81 / $14,479.00
| Facility | | $1,476.67 | $2,469.81 | $14,479.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,847.98 / $2,469.81 / $8,772.00
| Facility | | $1,847.98 | $2,469.81 | $8,772.00 |
- 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 |