- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,119.04
| Facility | | $3,496.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.13 / $3,221.07 / $7,326.00
| Professional | | $1,945.13 | $3,221.07 | $7,326.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,697.85 / $4,226.83 / $6,079.61
| Facility | | $2,697.85 | $4,226.83 | $6,079.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.05 / $4,599.68 / $6,535.44
| Facility | | $3,285.05 | $4,599.68 | $6,535.44 |
- 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 |