- 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
- $1,203.07 / $2,107.77 / $3,526.86
| Professional | | $1,203.07 | $2,107.77 | $3,526.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.94 / $3,049.91 / $6,608.00
| Facility | | $2,070.94 | $3,049.91 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,022.93 / $2,855.73 / $3,976.30
| Facility | | $2,022.93 | $2,855.73 | $3,976.30 |
- 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 |