- 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
- $1,692.15 / $2,675.70 / $6,191.77
| Professional | | $1,692.15 | $2,675.70 | $6,191.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,317.42 / $3,852.87 / $5,244.36
| Facility | | $2,317.42 | $3,852.87 | $5,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,171.43 / $4,039.99 / $5,219.00
| Facility | | $3,171.43 | $4,039.99 | $5,219.00 |
- 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 |