- 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
- $1,273.79 / $2,048.67 / $4,542.09
| Professional | | $1,273.79 | $2,048.67 | $4,542.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.08 / $2,626.44 / $4,663.00
| Facility | | $1,552.08 | $2,626.44 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,159.54 / $3,110.60 / $4,247.56
| Facility | | $2,159.54 | $3,110.60 | $4,247.56 |
- 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 |