- 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
- $1,164.47 / $1,843.71 / $3,892.48
| Professional | | $1,164.47 | $1,843.71 | $3,892.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.45 / $2,974.70 / $7,305.00
| Facility | | $1,866.45 | $2,974.70 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.29 / $2,718.32 / $3,674.82
| Facility | | $1,939.29 | $2,718.32 | $3,674.82 |
- 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 |