- 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
- $1,396.27 / $2,196.73 / $3,715.97
| Professional | | $1,396.27 | $2,196.73 | $3,715.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.14 / $3,396.00 / $6,608.00
| Facility | | $1,625.14 | $3,396.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,270.71 / $3,285.27 / $4,439.14
| Facility | | $2,270.71 | $3,285.27 | $4,439.14 |
- 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 |