- 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
- $731.41 / $1,149.58 / $2,033.37
| Professional | | $731.41 | $1,149.58 | $2,033.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.67 / $1,621.92 / $4,134.99
| Facility | | $920.67 | $1,621.92 | $4,134.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.23 / $1,736.53 / $2,304.71
| Facility | | $1,175.23 | $1,736.53 | $2,304.71 |
- 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 |