- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.86 / $2,895.57 / $6,710.95
| Professional | | $1,790.86 | $2,895.57 | $6,710.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,639.89 / $4,065.43 / $6,103.84
| Facility | | $2,639.89 | $4,065.43 | $6,103.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.68 / $4,265.62 / $5,535.72
| Facility | | $3,392.68 | $4,265.62 | $5,535.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,856.00
| Facility | | $2,126.00 | $5,847.00 | $7,856.00 |