- 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
- $1,229.70 / $1,968.68 / $3,787.39
| Professional | | $1,229.70 | $1,968.68 | $3,787.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.74 / $2,573.54 / $4,663.00
| Facility | | $1,620.74 | $2,573.54 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.68 / $2,984.69 / $4,021.75
| Facility | | $2,043.68 | $2,984.69 | $4,021.75 |
- 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 |