- 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
- $1,256.76 / $2,296.28 / $3,955.70
| Professional | | $1,256.76 | $2,296.28 | $3,955.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,391.54 / $3,276.54 / $7,305.00
| Facility | | $2,391.54 | $3,276.54 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,062.46 / $3,076.15 / $4,005.34
| Facility | | $2,062.46 | $3,076.15 | $4,005.34 |
- 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 |