- 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
- $1,547.56 / $2,444.91 / $5,207.84
| Professional | | $1,547.56 | $2,444.91 | $5,207.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,986.08 / $3,385.89 / $5,244.00
| Facility | | $1,986.08 | $3,385.89 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,472.06 / $3,662.28 / $5,207.89
| Facility | | $2,472.06 | $3,662.28 | $5,207.89 |
- 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 |