- 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
- $797.36 / $1,404.69 / $2,200.56
| Professional | | $797.36 | $1,404.69 | $2,200.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.54 / $2,076.00 / $6,608.00
| Facility | | $1,322.54 | $2,076.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.08 / $1,886.45 / $2,550.08
| Facility | | $1,295.08 | $1,886.45 | $2,550.08 |
- 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 |