- 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
- $1,340.12 / $2,268.19 / $3,811.01
| Professional | | $1,340.12 | $2,268.19 | $3,811.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,077.69 / $3,288.24 / $6,608.00
| Facility | | $2,077.69 | $3,288.24 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,181.69 / $3,213.23 / $4,298.85
| Facility | | $2,181.69 | $3,213.23 | $4,298.85 |
- 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 |