- 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
- $1,266.26 / $2,136.48 / $3,977.65
| Professional | | $1,266.26 | $2,136.48 | $3,977.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.42 / $3,330.58 / $7,305.00
| Facility | | $2,380.42 | $3,330.58 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,092.07 / $3,099.97 / $3,944.04
| Facility | | $2,092.07 | $3,099.97 | $3,944.04 |
- 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 |