- 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
- $1,139.06 / $1,794.56 / $3,968.07
| Professional | | $1,139.06 | $1,794.56 | $3,968.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.80 / $2,622.01 / $5,244.00
| Facility | | $1,632.80 | $2,622.01 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,865.61 / $2,680.47 / $3,828.22
| Facility | | $1,865.61 | $2,680.47 | $3,828.22 |
- 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 |