- 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
- $1,346.21 / $2,141.06 / $3,749.86
| Professional | | $1,346.21 | $2,141.06 | $3,749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.76 / $2,907.44 / $4,663.00
| Facility | | $1,769.76 | $2,907.44 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.03 / $3,185.57 / $4,453.97
| Facility | | $2,161.03 | $3,185.57 | $4,453.97 |
- 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 |