- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,405.00 / $10,255.42
| Facility | | $5,012.00 | $6,405.00 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.32 / $1,422.04 / $2,964.59
| Professional | | $904.32 | $1,422.04 | $2,964.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.98 / $2,083.10 / $4,663.00
| Facility | | $1,257.98 | $2,083.10 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,451.57 / $2,142.63 / $2,856.24
| Facility | | $1,451.57 | $2,142.63 | $2,856.24 |
- 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 |