- 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
- $1,049.75 / $1,811.54 / $2,812.35
| Professional | | $1,049.75 | $1,811.54 | $2,812.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.89 / $2,658.72 / $6,608.00
| Facility | | $1,940.89 | $2,658.72 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.72 / $2,512.35 / $3,299.98
| Facility | | $1,687.72 | $2,512.35 | $3,299.98 |
- 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 |