- 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
- $2,406.96 / $3,867.90 / $7,369.87
| Professional | | $2,406.96 | $3,867.90 | $7,369.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,396.00 / $5,406.28 / $7,457.23
| Facility | | $3,396.00 | $5,406.28 | $7,457.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,414.79 / $5,745.22 / $7,251.39
| Facility | | $4,414.79 | $5,745.22 | $7,251.39 |
- 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 |