- 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
- $1,257.47 / $2,036.55 / $4,030.62
| Professional | | $1,257.47 | $2,036.55 | $4,030.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.31 / $2,741.45 / $4,663.00
| Facility | | $1,691.31 | $2,741.45 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,102.40 / $3,044.36 / $4,230.76
| Facility | | $2,102.40 | $3,044.36 | $4,230.76 |
- 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 |