- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,098.00 / $11,100.08
| Facility | | $4,964.00 | $6,098.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,686.27 / $2,681.34 / $5,071.35
| Professional | | $1,686.27 | $2,681.34 | $5,071.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,205.21 / $4,150.33 / $7,305.00
| Facility | | $2,205.21 | $4,150.33 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,304.38 / $4,150.33 / $5,646.96
| Facility | | $3,304.38 | $4,150.33 | $5,646.96 |
- 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 |