- 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
- $933.13 / $1,463.33 / $2,542.69
| Professional | | $933.13 | $1,463.33 | $2,542.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,359.62 / $2,283.00 / $6,608.00
| Facility | | $1,359.62 | $2,283.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.14 / $2,210.31 / $2,935.80
| Facility | | $1,498.14 | $2,210.31 | $2,935.80 |
- 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 |