- 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
- $1,158.28 / $1,868.57 / $3,983.32
| Professional | | $1,158.28 | $1,868.57 | $3,983.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,795.19 / $2,780.24 / $6,608.00
| Facility | | $1,795.19 | $2,780.24 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.11 / $2,753.26 / $3,634.76
| Facility | | $1,854.11 | $2,753.26 | $3,634.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,305.00
| Facility | | $2,126.00 | $5,854.53 | $7,305.00 |