- 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
- $786.24 / $1,316.46 / $2,208.82
| Professional | | $786.24 | $1,316.46 | $2,208.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.92 / $1,948.69 / $6,608.00
| Facility | | $1,227.92 | $1,948.69 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.72 / $1,864.62 / $2,500.52
| Facility | | $1,268.72 | $1,864.62 | $2,500.52 |
- 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 |