- 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
- $3,918.23 / $6,551.65 / $10,768.40
| Professional | | $3,918.23 | $6,551.65 | $10,768.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,731.63 / $7,447.24 / $11,405.82
| Facility | | $4,731.63 | $7,447.24 | $11,405.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,049.63 / $9,219.49 / $11,808.59
| Facility | | $6,049.63 | $9,219.49 | $11,808.59 |
- 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 |