- 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
- $667.67 / $1,096.86 / $1,839.48
| Professional | | $667.67 | $1,096.86 | $1,839.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.08 / $1,922.53 / $8,083.26
| Facility | | $1,103.08 | $1,922.53 | $8,083.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.21 / $1,582.97 / $2,130.02
| Facility | | $1,131.21 | $1,582.97 | $2,130.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |