- 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
- $1,200.77 / $1,946.80 / $3,212.63
| Professional | | $1,200.77 | $1,946.80 | $3,212.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.74 / $2,886.00 / $6,608.00
| Facility | | $1,620.74 | $2,886.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.11 / $2,819.37 / $3,687.52
| Facility | | $1,887.11 | $2,819.37 | $3,687.52 |
- 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 |