- 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
- $2,755.18 / $4,614.68 / $9,986.20
| Professional | | $2,755.18 | $4,614.68 | $9,986.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,402.88 / $6,123.53 / $8,304.00
| Facility | | $3,402.88 | $6,123.53 | $8,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,577.00 / $6,721.92 / $9,539.86
| Facility | | $4,577.00 | $6,721.92 | $9,539.86 |
- 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 |