- 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
- $1,321.01 / $2,130.94 / $3,319.93
| Professional | | $1,321.01 | $2,130.94 | $3,319.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.91 / $3,542.10 / $13,498.08
| Facility | | $1,729.91 | $3,542.10 | $13,498.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.09 / $3,155.00 / $4,149.31
| Facility | | $2,064.09 | $3,155.00 | $4,149.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $12,871.00 / $16,293.00
| Facility | | $9,542.00 | $12,871.00 | $16,293.00 |