- 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
- $1,177.05 / $1,792.13 / $3,588.64
| Professional | | $1,177.05 | $1,792.13 | $3,588.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,402.74 / $2,470.34 / $4,663.00
| Facility | | $1,402.74 | $2,470.34 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,046.11 / $2,852.24 / $3,976.22
| Facility | | $2,046.11 | $2,852.24 | $3,976.22 |
- 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 |