- 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
- $2,741.13 / $4,549.07 / $7,700.42
| Professional | | $2,741.13 | $4,549.07 | $7,700.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,968.25 / $6,536.34 / $8,018.25
| Facility | | $3,968.25 | $6,536.34 | $8,018.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.72 / $6,454.64 / $8,261.12
| Facility | | $4,227.72 | $6,454.64 | $8,261.12 |
- 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 |