- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.40 / $1,577.75 / $2,743.22
| Professional | | $909.40 | $1,577.75 | $2,743.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.69 / $2,629.16 / $14,595.02
| Facility | | $1,828.69 | $2,629.16 | $14,595.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.73 / $2,269.86 / $2,968.83
| Facility | | $1,517.73 | $2,269.86 | $2,968.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |