- 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
- $811.32 / $1,270.08 / $2,305.79
| Professional | | $811.32 | $1,270.08 | $2,305.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.71 / $1,808.51 / $4,589.02
| Facility | | $1,028.71 | $1,808.51 | $4,589.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.46 / $1,936.67 / $2,577.32
| Facility | | $1,308.46 | $1,936.67 | $2,577.32 |
- 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 |