- 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
- $1,158.31 / $1,923.15 / $3,078.60
| Professional | | $1,158.31 | $1,923.15 | $3,078.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.17 / $2,867.22 / $6,608.00
| Facility | | $2,055.17 | $2,867.22 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.32 / $2,676.90 / $3,501.22
| Facility | | $1,791.32 | $2,676.90 | $3,501.22 |
- 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 |