- 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
- $668.23 / $1,142.01 / $1,986.79
| Professional | | $668.23 | $1,142.01 | $1,986.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.48 / $1,913.18 / $10,061.00
| Facility | | $1,340.48 | $1,913.18 | $10,061.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.00 / $2,195.25 / $3,170.91
| Facility | | $1,274.00 | $2,195.25 | $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 |