- 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
- $991.70 / $1,549.56 / $3,870.78
| Professional | | $991.70 | $1,549.56 | $3,870.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.97 / $2,126.00 / $4,663.00
| Facility | | $1,308.97 | $2,126.00 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,607.75 / $2,346.41 / $3,163.44
| Facility | | $1,607.75 | $2,346.41 | $3,163.44 |
- 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 |