- 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
- $1,494.80 / $2,528.01 / $4,503.26
| Professional | | $1,494.80 | $2,528.01 | $4,503.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,270.16 / $3,783.75 / $7,305.00
| Facility | | $2,270.16 | $3,783.75 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.87 / $3,610.59 / $4,706.35
| Facility | | $2,429.87 | $3,610.59 | $4,706.35 |
- 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 |