- 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
- $1,213.94 / $2,140.31 / $3,524.78
| Professional | | $1,213.94 | $2,140.31 | $3,524.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,247.00 / $3,074.53 / $6,608.00
| Facility | | $2,247.00 | $3,074.53 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.33 / $2,859.50 / $3,996.13
| Facility | | $2,041.33 | $2,859.50 | $3,996.13 |
- 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 |