- 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
- $1,000.27 / $1,585.43 / $4,275.24
| Professional | | $1,000.27 | $1,585.43 | $4,275.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.04 / $2,343.11 / $4,663.00
| Facility | | $1,390.04 | $2,343.11 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.58 / $2,371.88 / $3,296.88
| Facility | | $1,635.58 | $2,371.88 | $3,296.88 |
- 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 |