- 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
- $3,297.36 / $5,205.30 / $9,108.11
| Professional | | $3,297.36 | $5,205.30 | $9,108.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,011.03 / $7,305.00 / $9,556.90
| Facility | | $4,011.03 | $7,305.00 | $9,556.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,427.41 / $7,705.17 / $10,457.29
| Facility | | $5,427.41 | $7,705.17 | $10,457.29 |
- 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 |