- 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
- $1,980.54 / $3,332.90 / $6,106.48
| Professional | | $1,980.54 | $3,332.90 | $6,106.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,174.62 / $5,038.39 / $7,305.00
| Facility | | $3,174.62 | $5,038.39 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.09 / $4,881.81 / $6,252.74
| Facility | | $3,302.09 | $4,881.81 | $6,252.74 |
- 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 |