- 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
- $1,969.23 / $3,166.43 / $9,209.45
| Professional | | $1,969.23 | $3,166.43 | $9,209.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,865.52 / $4,496.47 / $6,445.54
| Facility | | $2,865.52 | $4,496.47 | $6,445.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,646.24 / $4,706.66 / $5,951.90
| Facility | | $3,646.24 | $4,706.66 | $5,951.90 |
- 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 |