- 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
- $1,025.34 / $1,573.97 / $3,100.79
| Professional | | $1,025.34 | $1,573.97 | $3,100.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.76 / $2,426.69 / $9,346.00
| Facility | | $1,479.76 | $2,426.69 | $9,346.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.25 / $2,428.65 / $3,351.28
| Facility | | $1,703.25 | $2,428.65 | $3,351.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $9,082.00 / $13,476.00
| Facility | | $1,770.00 | $9,082.00 | $13,476.00 |