- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,508.46 / $2,437.05 / $6,055.37
| Professional | | $1,508.46 | $2,437.05 | $6,055.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,306.16 / $3,628.85 / $7,123.00
| Facility | | $2,306.16 | $3,628.85 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,418.19 / $3,582.95 / $4,746.30
| Facility | | $2,418.19 | $3,582.95 | $4,746.30 |
- 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 |