- 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
- $1,095.02 / $1,764.79 / $4,386.42
| Professional | | $1,095.02 | $1,764.79 | $4,386.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.25 / $2,306.26 / $4,663.00
| Facility | | $1,374.25 | $2,306.26 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.92 / $2,666.66 / $3,560.97
| Facility | | $1,799.92 | $2,666.66 | $3,560.97 |
- 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 |