- 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
- $1,809.52 / $2,864.82 / $6,818.56
| Professional | | $1,809.52 | $2,864.82 | $6,818.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,655.97 / $4,617.00 / $7,305.00
| Facility | | $2,655.97 | $4,617.00 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,018.09 / $4,446.75 / $5,699.40
| Facility | | $3,018.09 | $4,446.75 | $5,699.40 |
- 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 |