- 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
- $1,124.22 / $1,941.74 / $3,265.81
| Professional | | $1,124.22 | $1,941.74 | $3,265.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,916.74 / $2,950.00 / $6,608.00
| Facility | | $1,916.74 | $2,950.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.62 / $2,648.45 / $3,696.84
| Facility | | $1,883.62 | $2,648.45 | $3,696.84 |
- 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 |