- 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
- $1,247.81 / $1,962.26 / $3,375.99
| Professional | | $1,247.81 | $1,962.26 | $3,375.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.42 / $2,583.32 / $4,663.00
| Facility | | $1,618.42 | $2,583.32 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.22 / $2,954.12 / $3,972.90
| Facility | | $2,005.22 | $2,954.12 | $3,972.90 |
- 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 |