- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $9,248.33
| Facility | | $3,496.00 | $5,091.00 | $9,248.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $1,022.87 / $1,764.21
| Professional | | $597.91 | $1,022.87 | $1,764.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.18 / $1,782.17 / $10,061.00
| Facility | | $1,230.18 | $1,782.17 | $10,061.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.00 / $1,975.18 / $3,170.91
| Facility | | $1,135.00 | $1,975.18 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |