- 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
- $735.88 / $1,148.26 / $1,934.62
| Professional | | $735.88 | $1,148.26 | $1,934.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.71 / $1,899.87 / $6,608.00
| Facility | | $1,037.71 | $1,899.87 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.69 / $1,745.26 / $2,328.42
| Facility | | $1,181.69 | $1,745.26 | $2,328.42 |
- 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 |