- 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
- $2,108.05 / $3,319.11 / $7,995.92
| Professional | | $2,108.05 | $3,319.11 | $7,995.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,464.86 / $4,138.06 / $6,369.43
| Facility | | $2,464.86 | $4,138.06 | $6,369.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,381.26 / $4,975.93 / $6,652.23
| Facility | | $3,381.26 | $4,975.93 | $6,652.23 |
- 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 |