- 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
- $1,251.06 / $1,955.69 / $3,618.02
| Professional | | $1,251.06 | $1,955.69 | $3,618.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.27 / $3,083.06 / $6,608.00
| Facility | | $1,715.27 | $3,083.06 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,081.08 / $2,936.66 / $4,005.31
| Facility | | $2,081.08 | $2,936.66 | $4,005.31 |
- 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 |