- 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
- $1,185.95 / $1,964.18 / $3,084.71
| Professional | | $1,185.95 | $1,964.18 | $3,084.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.32 / $2,914.96 / $6,608.00
| Facility | | $2,098.32 | $2,914.96 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.51 / $2,723.68 / $3,562.40
| Facility | | $1,818.51 | $2,723.68 | $3,562.40 |
- 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 |