- 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
- $1,234.90 / $1,941.71 / $3,765.15
| Professional | | $1,234.90 | $1,941.71 | $3,765.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.23 / $2,622.35 / $4,663.00
| Facility | | $1,626.23 | $2,622.35 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,997.12 / $2,927.21 / $4,008.84
| Facility | | $1,997.12 | $2,927.21 | $4,008.84 |
- 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 |