- 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
- $1,782.98 / $2,811.12 / $5,774.90
| Professional | | $1,782.98 | $2,811.12 | $5,774.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.78 / $3,506.82 / $5,385.18
| Facility | | $1,982.78 | $3,506.82 | $5,385.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,863.04 / $4,215.39 / $5,631.46
| Facility | | $2,863.04 | $4,215.39 | $5,631.46 |
- 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 |