- 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
- $2,209.15 / $3,679.13 / $6,379.84
| Professional | | $2,209.15 | $3,679.13 | $6,379.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,927.45 / $5,117.06 / $6,878.83
| Facility | | $2,927.45 | $5,117.06 | $6,878.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,445.55 / $5,117.06 / $6,692.75
| Facility | | $3,445.55 | $5,117.06 | $6,692.75 |
- 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 |