- 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
- $1,222.11 / $2,234.27 / $3,943.50
| Professional | | $1,222.11 | $2,234.27 | $3,943.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $3,314.60 / $7,305.00
| Facility | | $2,337.00 | $3,314.60 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.19 / $3,047.57 / $3,897.35
| Facility | | $2,064.19 | $3,047.57 | $3,897.35 |
- 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 |