- 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
- $1,788.62 / $2,794.53 / $5,763.79
| Professional | | $1,788.62 | $2,794.53 | $5,763.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,118.15 / $3,829.09 / $5,452.81
| Facility | | $2,118.15 | $3,829.09 | $5,452.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,870.00 / $4,221.95 / $5,716.47
| Facility | | $2,870.00 | $4,221.95 | $5,716.47 |
- 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 |