- 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
- $2,830.02 / $4,817.10 / $8,135.79
| Professional | | $2,830.02 | $4,817.10 | $8,135.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,212.78 / $6,748.85 / $8,658.14
| Facility | | $4,212.78 | $6,748.85 | $8,658.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,615.82 / $6,848.03 / $9,061.70
| Facility | | $4,615.82 | $6,848.03 | $9,061.70 |
- 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 |