- 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
- $2,120.44 / $3,732.78 / $6,176.68
| Professional | | $2,120.44 | $3,732.78 | $6,176.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,336.51 / $5,249.48 / $7,305.00
| Facility | | $3,336.51 | $5,249.48 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,563.92 / $4,986.14 / $6,990.10
| Facility | | $3,563.92 | $4,986.14 | $6,990.10 |
- 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 |