- 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
- $1,137.98 / $1,872.50 / $5,275.18
| Professional | | $1,137.98 | $1,872.50 | $5,275.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.98 / $1,733.95 / $6,572.00
| Facility | | $1,122.98 | $1,733.95 | $6,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.11 / $2,160.87 / $2,809.26
| Facility | | $1,469.11 | $2,160.87 | $2,809.26 |
- 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 |