- 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
- $2,727.26 / $4,270.77 / $8,478.20
| Professional | | $2,727.26 | $4,270.77 | $8,478.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,120.76 / $5,238.83 / $7,400.29
| Facility | | $3,120.76 | $5,238.83 | $7,400.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,809.51 / $6,049.53 / $8,701.70
| Facility | | $3,809.51 | $6,049.53 | $8,701.70 |
- 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 |