- 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
- $3,069.22 / $5,147.91 / $12,688.12
| Professional | | $3,069.22 | $5,147.91 | $12,688.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,794.09 / $6,844.36 / $9,256.24
| Facility | | $3,794.09 | $6,844.36 | $9,256.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,106.26 / $7,491.22 / $10,647.32
| Facility | | $5,106.26 | $7,491.22 | $10,647.32 |
- 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 |