- 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
- $2,287.23 / $3,825.09 / $6,937.12
| Professional | | $2,287.23 | $3,825.09 | $6,937.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,493.96 / $5,207.91 / $7,047.24
| Facility | | $2,493.96 | $5,207.91 | $7,047.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.21 / $5,290.73 / $6,893.16
| Facility | | $3,548.21 | $5,290.73 | $6,893.16 |
- 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 |