- 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
- $2,144.90 / $3,247.07 / $7,423.29
| Professional | | $2,144.90 | $3,247.07 | $7,423.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.07 / $4,458.70 / $6,608.00
| Facility | | $2,500.07 | $4,458.70 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,680.06 / $5,141.88 / $7,166.51
| Facility | | $3,680.06 | $5,141.88 | $7,166.51 |
- 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 |