- 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
- $1,674.85 / $2,760.29 / $6,281.50
| Professional | | $1,674.85 | $2,760.29 | $6,281.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.60 / $3,780.08 / $5,469.24
| Facility | | $2,454.60 | $3,780.08 | $5,469.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,122.16 / $4,003.61 / $5,093.18
| Facility | | $3,122.16 | $4,003.61 | $5,093.18 |
- 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 |