- 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
- $1,000.31 / $1,786.89 / $3,038.55
| Professional | | $1,000.31 | $1,786.89 | $3,038.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,051.00 / $2,723.94 / $7,305.00
| Facility | | $2,051.00 | $2,723.94 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.73 / $2,447.27 / $3,166.79
| Facility | | $1,656.73 | $2,447.27 | $3,166.79 |
- 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 |