- 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
- $1,166.11 / $1,836.41 / $4,437.85
| Professional | | $1,166.11 | $1,836.41 | $4,437.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.49 / $2,671.28 / $5,244.00
| Facility | | $1,616.49 | $2,671.28 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.83 / $2,756.90 / $3,898.12
| Facility | | $1,886.83 | $2,756.90 | $3,898.12 |
- 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 |