- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.97 / $2,814.76 / $4,873.60
| Professional | | $1,872.97 | $2,814.76 | $4,873.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.88 / $4,583.22 / $6,608.00
| Facility | | $2,100.88 | $4,583.22 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,081.00 / $4,486.85 / $6,246.76
| Facility | | $3,081.00 | $4,486.85 | $6,246.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |