- 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
- $1,479.06 / $2,434.01 / $3,753.23
| Professional | | $1,479.06 | $2,434.01 | $3,753.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.83 / $3,307.43 / $5,244.00
| Facility | | $786.83 | $3,307.43 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.57 / $3,375.96 / $4,415.51
| Facility | | $2,266.57 | $3,375.96 | $4,415.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |