- 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
- $2,242.44 / $3,309.92 / $5,394.08
| Professional | | $2,242.44 | $3,309.92 | $5,394.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.69 / $4,159.06 / $7,154.63
| Facility | | $2,104.69 | $4,159.06 | $7,154.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,962.59 / $5,565.47 / $7,502.20
| Facility | | $2,962.59 | $5,565.47 | $7,502.20 |
- 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 |