- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.99 / $2,183.04 / $3,458.17
| Professional | | $1,314.99 | $2,183.04 | $3,458.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $3,220.61 / $6,608.00
| Facility | | $2,337.00 | $3,220.61 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.34 / $3,033.36 / $3,967.45
| Facility | | $2,021.34 | $3,033.36 | $3,967.45 |
- 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 |