- 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
- $1,138.17 / $1,788.05 / $3,858.27
| Professional | | $1,138.17 | $1,788.05 | $3,858.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.03 / $2,406.53 / $4,663.00
| Facility | | $1,462.03 | $2,406.53 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.61 / $2,697.21 / $3,594.48
| Facility | | $1,821.61 | $2,697.21 | $3,594.48 |
- 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 |