- 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
- $1,335.57 / $2,252.31 / $3,657.29
| Professional | | $1,335.57 | $2,252.31 | $3,657.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $3,292.43 / $6,608.00
| Facility | | $2,337.00 | $3,292.43 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,177.65 / $3,166.65 / $4,306.27
| Facility | | $2,177.65 | $3,166.65 | $4,306.27 |
- 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 |