- 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
- $2,953.76 / $4,950.32 / $10,764.54
| Professional | | $2,953.76 | $4,950.32 | $10,764.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,680.82 / $6,632.56 / $8,978.48
| Facility | | $3,680.82 | $6,632.56 | $8,978.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,916.93 / $7,206.64 / $10,234.37
| Facility | | $4,916.93 | $7,206.64 | $10,234.37 |
- 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 |