- 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
- $2,006.91 / $3,387.48 / $6,663.01
| Professional | | $2,006.91 | $3,387.48 | $6,663.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,946.58 / $4,751.06 / $6,608.00
| Facility | | $2,946.58 | $4,751.06 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,305.67 / $4,771.58 / $6,519.67
| Facility | | $3,305.67 | $4,771.58 | $6,519.67 |
- 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 |