- 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
- $744.88 / $1,278.96 / $2,228.42
| Professional | | $744.88 | $1,278.96 | $2,228.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.64 / $1,917.75 / $6,608.00
| Facility | | $1,153.64 | $1,917.75 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.22 / $1,793.84 / $2,346.23
| Facility | | $1,199.22 | $1,793.84 | $2,346.23 |
- 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 |