- 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
- $1,403.01 / $2,362.48 / $2,954.33
| Professional | | $1,403.01 | $2,362.48 | $2,954.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.05 / $3,651.35 / $7,305.00
| Facility | | $2,332.05 | $3,651.35 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.50 / $3,468.67 / $4,469.47
| Facility | | $2,344.50 | $3,468.67 | $4,469.47 |
- 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 |