- 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
- $1,256.59 / $2,148.78 / $3,733.63
| Professional | | $1,256.59 | $2,148.78 | $3,733.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,357.00 / $3,634.20 / $11,732.00
| Facility | | $2,357.00 | $3,634.20 | $11,732.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.49 / $3,065.48 / $4,009.45
| Facility | | $2,045.49 | $3,065.48 | $4,009.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,133.00 / $7,487.00 / $11,732.00
| Facility | | $4,133.00 | $7,487.00 | $11,732.00 |