- 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
- $2,163.38 / $3,298.20 / $8,793.70
| Professional | | $2,163.38 | $3,298.20 | $8,793.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,794.77 / $4,898.00 / $6,678.66
| Facility | | $2,794.77 | $4,898.00 | $6,678.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,708.12 / $5,192.82 / $7,194.37
| Facility | | $3,708.12 | $5,192.82 | $7,194.37 |
- 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 |