- 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
- $2,679.73 / $4,372.29 / $7,524.00
| Professional | | $2,679.73 | $4,372.29 | $7,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,773.84 / $6,315.23 / $8,074.59
| Facility | | $3,773.84 | $6,315.23 | $8,074.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,298.64 / $6,403.88 / $8,386.58
| Facility | | $4,298.64 | $6,403.88 | $8,386.58 |
- 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 |