- 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
- $1,089.20 / $1,699.31 / $3,748.47
| Professional | | $1,089.20 | $1,699.31 | $3,748.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.15 / $2,504.34 / $4,663.00
| Facility | | $1,497.15 | $2,504.34 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.26 / $2,576.41 / $3,471.75
| Facility | | $1,767.26 | $2,576.41 | $3,471.75 |
- 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 |