- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,423.37 / $4,196.66 / $7,331.08
| Professional | | $2,423.37 | $4,196.66 | $7,331.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,460.94 / $6,026.21 / $7,476.56
| Facility | | $3,460.94 | $6,026.21 | $7,476.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,080.76 / $6,110.12 / $7,991.63
| Facility | | $4,080.76 | $6,110.12 | $7,991.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |