- 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
- $2,174.10 / $3,607.47 / $7,321.83
| Professional | | $2,174.10 | $3,607.47 | $7,321.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,499.28 / $4,506.59 / $6,927.13
| Facility | | $2,499.28 | $4,506.59 | $6,927.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,643.00 / $5,407.52 / $7,247.30
| Facility | | $3,643.00 | $5,407.52 | $7,247.30 |
- 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 |