- 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
- $2,189.40 / $3,442.04 / $5,768.09
| Professional | | $2,189.40 | $3,442.04 | $5,768.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.08 / $5,246.69 / $6,659.33
| Facility | | $2,951.08 | $5,246.69 | $6,659.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,505.81 / $5,246.69 / $6,901.47
| Facility | | $3,505.81 | $5,246.69 | $6,901.47 |
- 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 |