- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.90 / $2,352.00 / $6,298.62
| Facility | | $1,866.90 | $2,352.00 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.21 / $1,313.84 / $2,028.24
| Professional | | $742.21 | $1,313.84 | $2,028.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,359.62 / $1,794.62 / $8,165.52
| Facility | | $1,359.62 | $1,794.62 | $8,165.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.93 / $1,545.86 / $1,799.75
| Facility | | $1,164.93 | $1,545.86 | $1,799.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $6,110.41 / $8,342.00
| Facility | | $3,711.00 | $6,110.41 | $8,342.00 |