- 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
- $645.84 / $1,037.36 / $1,863.98
| Professional | | $645.84 | $1,037.36 | $1,863.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.41 / $1,706.56 / $7,255.44
| Facility | | $1,053.41 | $1,706.56 | $7,255.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.52 / $1,526.20 / $2,075.36
| Facility | | $1,064.52 | $1,526.20 | $2,075.36 |
- 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 |