- 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
- $1,465.54 / $2,306.42 / $6,146.00
| Professional | | $1,465.54 | $2,306.42 | $6,146.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,961.73 / $3,465.57 / $6,608.00
| Facility | | $1,961.73 | $3,465.57 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,390.10 / $3,448.31 / $4,678.22
| Facility | | $2,390.10 | $3,448.31 | $4,678.22 |
- 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 |