- 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
- $1,277.34 / $2,223.32 / $3,908.05
| Professional | | $1,277.34 | $2,223.32 | $3,908.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.75 / $3,157.86 / $6,608.00
| Facility | | $1,943.75 | $3,157.86 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.91 / $3,010.60 / $3,876.84
| Facility | | $2,093.91 | $3,010.60 | $3,876.84 |
- 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 |