- 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
- $2,260.92 / $3,843.81 / $6,520.79
| Professional | | $2,260.92 | $3,843.81 | $6,520.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,666.72 / $5,646.75 / $7,305.00
| Facility | | $3,666.72 | $5,646.75 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,712.89 / $5,562.03 / $7,224.63
| Facility | | $3,712.89 | $5,562.03 | $7,224.63 |
- 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 |