- 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
- $1,517.50 / $2,389.44 / $5,091.09
| Professional | | $1,517.50 | $2,389.44 | $5,091.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,977.94 / $3,194.46 / $4,898.00
| Facility | | $1,977.94 | $3,194.46 | $4,898.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.21 / $3,588.03 / $4,906.81
| Facility | | $2,439.21 | $3,588.03 | $4,906.81 |
- 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 |