- 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
- $2,679.71 / $4,417.33 / $9,034.15
| Professional | | $2,679.71 | $4,417.33 | $9,034.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,380.81 / $5,842.69 / $8,063.45
| Facility | | $3,380.81 | $5,842.69 | $8,063.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,526.93 / $6,566.90 / $9,167.04
| Facility | | $4,526.93 | $6,566.90 | $9,167.04 |
- 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 |