- 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
- $1,227.78 / $2,037.44 / $3,571.49
| Professional | | $1,227.78 | $2,037.44 | $3,571.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,942.62 / $3,104.24 / $6,608.00
| Facility | | $1,942.62 | $3,104.24 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.39 / $2,893.73 / $4,040.98
| Facility | | $2,058.39 | $2,893.73 | $4,040.98 |
- 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 |