- 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
- $1,442.59 / $2,202.65 / $5,014.93
| Professional | | $1,442.59 | $2,202.65 | $5,014.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.59 / $3,516.20 / $11,688.00
| Facility | | $2,080.59 | $3,516.20 | $11,688.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,653.00 / $3,456.32 / $4,323.00
| Facility | | $2,653.00 | $3,456.32 | $4,323.00 |
- 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 |