- 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
- $968.88 / $1,541.61 / $3,107.74
| Professional | | $968.88 | $1,541.61 | $3,107.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.72 / $2,167.39 / $4,663.00
| Facility | | $1,324.72 | $2,167.39 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.43 / $2,291.83 / $3,194.23
| Facility | | $1,608.43 | $2,291.83 | $3,194.23 |
- 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 |