- 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
- $717.35 / $1,121.60 / $2,275.21
| Professional | | $717.35 | $1,121.60 | $2,275.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.96 / $1,661.59 / $4,068.82
| Facility | | $967.96 | $1,661.59 | $4,068.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.38 / $1,708.88 / $2,319.35
| Facility | | $1,144.38 | $1,708.88 | $2,319.35 |
- 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 |