- 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
- $1,379.41 / $2,241.51 / $4,680.17
| Professional | | $1,379.41 | $2,241.51 | $4,680.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.65 / $3,245.35 / $4,981.14
| Facility | | $1,969.65 | $3,245.35 | $4,981.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,609.90 / $3,294.74 / $4,318.00
| Facility | | $2,609.90 | $3,294.74 | $4,318.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,856.00
| Facility | | $2,126.00 | $5,847.00 | $7,856.00 |