- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.02 / $1,411.00 / $3,063.27
| Professional | | $856.02 | $1,411.00 | $3,063.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.24 / $2,095.34 / $4,663.00
| Facility | | $1,202.24 | $2,095.34 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.20 / $2,225.67 / $2,983.54
| Facility | | $1,511.20 | $2,225.67 | $2,983.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |