- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $7,943.37
| Facility | | $4,693.00 | $5,549.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.92 / $1,655.87 / $4,715.82
| Professional | | $1,103.92 | $1,655.87 | $4,715.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.58 / $2,647.85 / $7,125.51
| Facility | | $1,437.58 | $2,647.85 | $7,125.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.35 / $2,508.71 / $3,567.53
| Facility | | $1,976.35 | $2,508.71 | $3,567.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |