- 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
- $1,528.48 / $2,671.20 / $4,169.00
| Professional | | $1,528.48 | $2,671.20 | $4,169.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.08 / $3,746.27 / $6,608.00
| Facility | | $2,660.08 | $3,746.27 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.64 / $3,538.95 / $4,628.70
| Facility | | $2,358.64 | $3,538.95 | $4,628.70 |
- 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 |