- 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
- $764.68 / $1,250.04 / $2,539.66
| Professional | | $764.68 | $1,250.04 | $2,539.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.96 / $2,012.95 / $8,604.00
| Facility | | $1,272.96 | $2,012.95 | $8,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.17 / $1,940.15 / $2,537.57
| Facility | | $1,506.17 | $1,940.15 | $2,537.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,234.00 / $9,673.00 / $14,242.22
| Facility | | $7,234.00 | $9,673.00 | $14,242.22 |