- 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
- $1,000.41 / $1,594.91 / $2,868.69
| Professional | | $1,000.41 | $1,594.91 | $2,868.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.84 / $2,247.42 / $4,663.00
| Facility | | $1,316.84 | $2,247.42 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.98 / $2,423.57 / $3,234.67
| Facility | | $1,644.98 | $2,423.57 | $3,234.67 |
- 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 |