- 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
- $1,508.57 / $2,380.59 / $4,328.96
| Professional | | $1,508.57 | $2,380.59 | $4,328.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.94 / $3,841.46 / $7,305.00
| Facility | | $2,147.94 | $3,841.46 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.52 / $3,794.56 / $4,794.50
| Facility | | $2,468.52 | $3,794.56 | $4,794.50 |
- 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 |