- 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
- $648.27 / $1,041.74 / $1,825.91
| Professional | | $648.27 | $1,041.74 | $1,825.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.97 / $1,585.45 / $5,847.00
| Facility | | $825.97 | $1,585.45 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.94 / $1,598.85 / $2,158.67
| Facility | | $1,063.94 | $1,598.85 | $2,158.67 |
- 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 |