- 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
- $1,748.19 / $2,671.15 / $3,857.75
| Professional | | $1,748.19 | $2,671.15 | $3,857.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,703.47 / $4,368.53 / $7,305.00
| Facility | | $2,703.47 | $4,368.53 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,561.00 / $4,103.33 / $5,587.16
| Facility | | $2,561.00 | $4,103.33 | $5,587.16 |
- 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 |