- 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
- $824.34 / $1,359.81 / $2,020.02
| Professional | | $824.34 | $1,359.81 | $2,020.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.87 / $2,163.71 / $6,423.40
| Facility | | $1,379.87 | $2,163.71 | $6,423.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.15 / $1,693.03 / $2,406.79
| Facility | | $1,267.15 | $1,693.03 | $2,406.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,988.00 / $8,342.00
| Facility | | $3,711.00 | $5,988.00 | $8,342.00 |