- 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
- $2,040.02 / $3,388.07 / $5,591.68
| Professional | | $2,040.02 | $3,388.07 | $5,591.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.80 / $4,881.63 / $6,879.04
| Facility | | $2,966.80 | $4,881.63 | $6,879.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.52 / $4,708.67 / $6,158.61
| Facility | | $3,159.52 | $4,708.67 | $6,158.61 |
- 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 |