- 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
- $1,717.45 / $2,924.57 / $5,083.52
| Professional | | $1,717.45 | $2,924.57 | $5,083.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.00 / $4,387.91 / $7,305.00
| Facility | | $2,950.00 | $4,387.91 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,837.07 / $4,174.28 / $5,404.59
| Facility | | $2,837.07 | $4,174.28 | $5,404.59 |
- 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 |