- 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
- $1,450.49 / $2,475.08 / $4,288.67
| Professional | | $1,450.49 | $2,475.08 | $4,288.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,348.94 / $3,652.33 / $6,608.00
| Facility | | $2,348.94 | $3,652.33 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,357.52 / $3,528.00 / $4,614.39
| Facility | | $2,357.52 | $3,528.00 | $4,614.39 |
- 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 |