- 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
- $1,331.67 / $2,196.94 / $3,605.70
| Professional | | $1,331.67 | $2,196.94 | $3,605.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $3,233.54 / $6,608.00
| Facility | | $2,337.00 | $3,233.54 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.34 / $3,115.99 / $4,075.51
| Facility | | $2,070.34 | $3,115.99 | $4,075.51 |
- 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 |