- 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
- $1,903.30 / $3,164.18 / $4,977.47
| Professional | | $1,903.30 | $3,164.18 | $4,977.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.37 / $4,530.39 / $6,608.00
| Facility | | $2,747.37 | $4,530.39 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,921.43 / $4,377.37 / $5,725.30
| Facility | | $2,921.43 | $4,377.37 | $5,725.30 |
- 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 |