- 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
- $737.33 / $1,156.14 / $2,544.85
| Professional | | $737.33 | $1,156.14 | $2,544.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.89 / $1,897.49 / $7,123.00
| Facility | | $987.89 | $1,897.49 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.18 / $1,741.61 / $2,342.06
| Facility | | $1,201.18 | $1,741.61 | $2,342.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,305.00
| Facility | | $2,126.00 | $5,854.53 | $7,305.00 |