- 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
- $1,191.94 / $1,875.44 / $4,753.35
| Professional | | $1,191.94 | $1,875.44 | $4,753.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,580.00 / $2,542.27 / $4,663.00
| Facility | | $1,580.00 | $2,542.27 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,952.02 / $2,817.29 / $3,902.34
| Facility | | $1,952.02 | $2,817.29 | $3,902.34 |
- 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 |