- 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
- $1,315.17 / $2,145.38 / $3,754.76
| Professional | | $1,315.17 | $2,145.38 | $3,754.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.92 / $3,310.93 / $6,608.00
| Facility | | $2,294.92 | $3,310.93 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.82 / $3,096.77 / $4,177.42
| Facility | | $2,137.82 | $3,096.77 | $4,177.42 |
- 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 |