- 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
- $719.64 / $1,129.02 / $1,939.69
| Professional | | $719.64 | $1,129.02 | $1,939.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.77 / $1,892.33 / $6,608.00
| Facility | | $1,145.77 | $1,892.33 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.41 / $1,711.78 / $2,271.31
| Facility | | $1,154.41 | $1,711.78 | $2,271.31 |
- 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 |