- 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
- $1,058.65 / $1,663.79 / $4,536.38
| Professional | | $1,058.65 | $1,663.79 | $4,536.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.41 / $2,530.94 / $6,608.00
| Facility | | $1,307.41 | $2,530.94 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.72 / $2,524.73 / $3,310.34
| Facility | | $1,676.72 | $2,524.73 | $3,310.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,305.00
| Facility | | $2,126.00 | $5,854.53 | $7,305.00 |