- 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
- $746.26 / $1,312.87 / $2,102.00
| Professional | | $746.26 | $1,312.87 | $2,102.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.78 / $1,985.91 / $6,587.28
| Facility | | $1,468.78 | $1,985.91 | $6,587.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.19 / $1,772.70 / $2,442.58
| Facility | | $1,240.19 | $1,772.70 | $2,442.58 |
- 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 |