- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,119.04
| Facility | | $3,496.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.44 / $1,688.67 / $7,270.40
| Professional | | $1,043.44 | $1,688.67 | $7,270.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.39 / $2,479.61 / $15,085.17
| Facility | | $1,411.39 | $2,479.61 | $15,085.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,668.20 / $2,479.61 / $3,414.87
| Facility | | $1,668.20 | $2,479.61 | $3,414.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $9,082.00 / $13,476.00
| Facility | | $1,770.00 | $9,082.00 | $13,476.00 |