- 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
- $1,688.31 / $2,840.16 / $5,444.15
| Professional | | $1,688.31 | $2,840.16 | $5,444.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,765.37 / $4,321.50 / $7,305.00
| Facility | | $2,765.37 | $4,321.50 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,789.45 / $4,134.31 / $5,318.87
| Facility | | $2,789.45 | $4,134.31 | $5,318.87 |
- 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 |