- 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
- $1,132.11 / $1,871.69 / $2,886.63
| Professional | | $1,132.11 | $1,871.69 | $2,886.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,817.69 / $2,721.24 / $6,608.00
| Facility | | $1,817.69 | $2,721.24 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.36 / $2,603.19 / $3,404.82
| Facility | | $1,732.36 | $2,603.19 | $3,404.82 |
- 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 |