- 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
- $1,253.73 / $2,028.71 / $4,685.06
| Professional | | $1,253.73 | $2,028.71 | $4,685.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,966.00 / $3,234.38 / $6,608.00
| Facility | | $1,966.00 | $3,234.38 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.75 / $3,056.12 / $3,997.22
| Facility | | $2,030.75 | $3,056.12 | $3,997.22 |
- 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 |