- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,098.00 / $11,100.08
| Facility | | $4,964.00 | $6,098.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.84 / $1,617.47 / $2,797.04
| Professional | | $959.84 | $1,617.47 | $2,797.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.67 / $2,436.84 / $6,608.00
| Facility | | $1,476.67 | $2,436.84 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.02 / $2,263.46 / $3,167.08
| Facility | | $1,610.02 | $2,263.46 | $3,167.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |