- 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
- $1,436.30 / $2,244.79 / $4,890.95
| Professional | | $1,436.30 | $2,244.79 | $4,890.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,889.85 / $3,073.40 / $4,663.00
| Facility | | $1,889.85 | $3,073.40 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.85 / $3,401.73 / $4,615.60
| Facility | | $2,318.85 | $3,401.73 | $4,615.60 |
- 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 |