- 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
- $1,025.83 / $1,736.01 / $3,245.65
| Professional | | $1,025.83 | $1,736.01 | $3,245.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,904.36 / $2,759.80 / $7,305.00
| Facility | | $1,904.36 | $2,759.80 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.02 / $2,492.41 / $3,259.92
| Facility | | $1,684.02 | $2,492.41 | $3,259.92 |
- 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 |