- 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
- $1,521.30 / $2,452.14 / $4,102.97
| Professional | | $1,521.30 | $2,452.14 | $4,102.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.02 / $3,655.45 / $6,608.00
| Facility | | $2,386.02 | $3,655.45 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,461.59 / $3,610.60 / $4,879.85
| Facility | | $2,461.59 | $3,610.60 | $4,879.85 |
- 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 |