- 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
- $742.12 / $1,219.30 / $2,801.85
| Professional | | $742.12 | $1,219.30 | $2,801.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.80 / $1,935.98 / $6,608.00
| Facility | | $1,226.80 | $1,935.98 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.51 / $1,762.00 / $2,348.62
| Facility | | $1,192.51 | $1,762.00 | $2,348.62 |
- 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 |