- 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
- $999.93 / $1,605.72 / $3,320.39
| Professional | | $999.93 | $1,605.72 | $3,320.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.84 / $2,218.13 / $4,663.00
| Facility | | $1,316.84 | $2,218.13 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.54 / $2,388.78 / $3,262.61
| Facility | | $1,545.54 | $2,388.78 | $3,262.61 |
- 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 |