- 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
- $2,154.30 / $5,880.07 / $9,669.51
| Professional | | $2,154.30 | $5,880.07 | $9,669.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.71 / $7,407.10 / $10,730.85
| Facility | | $4,140.71 | $7,407.10 | $10,730.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,911.00 / $8,750.29 / $11,876.97
| Facility | | $5,911.00 | $8,750.29 | $11,876.97 |
- 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 |