- 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
- $1,293.60 / $2,142.71 / $3,403.49
| Professional | | $1,293.60 | $2,142.71 | $3,403.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.12 / $3,162.61 / $6,608.00
| Facility | | $2,292.12 | $3,162.61 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,986.12 / $2,973.06 / $3,888.55
| Facility | | $1,986.12 | $2,973.06 | $3,888.55 |
- 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 |