- 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
- $874.77 / $1,478.59 / $2,789.65
| Professional | | $874.77 | $1,478.59 | $2,789.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.65 / $2,246.17 / $7,305.00
| Facility | | $1,440.65 | $2,246.17 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.82 / $2,046.56 / $2,788.23
| Facility | | $1,449.82 | $2,046.56 | $2,788.23 |
- 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 |