- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,918.31 / $11,748.98
| Facility | | $3,388.44 | $6,918.31 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $9,120.11
| Facility | | $3,630.78 | $4,570.88 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,073.80 / $4,466.84
| Professional | | $3,467.37 | $4,073.80 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,981.07 / $6,760.83
| Facility | | $3,311.31 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,715.35 / $4,168.69
| Professional | | $3,388.44 | $3,715.35 | $4,168.69 |