- 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
- $1,359.46 / $2,233.60 / $3,993.42
| Professional | | $1,359.46 | $2,233.60 | $3,993.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,955.00 / $3,372.88 / $6,608.00
| Facility | | $1,955.00 | $3,372.88 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.52 / $3,197.21 / $4,474.79
| Facility | | $2,298.52 | $3,197.21 | $4,474.79 |
- 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 |