- 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
- $864.80 / $1,490.25 / $2,624.58
| Professional | | $864.80 | $1,490.25 | $2,624.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.08 / $2,259.42 / $7,305.00
| Facility | | $1,416.08 | $2,259.42 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.04 / $2,106.62 / $2,755.31
| Facility | | $1,398.04 | $2,106.62 | $2,755.31 |
- 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 |