- 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
- $978.46 / $1,641.16 / $2,769.46
| Professional | | $978.46 | $1,641.16 | $2,769.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,783.94 / $2,577.53 / $6,608.00
| Facility | | $1,783.94 | $2,577.53 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.95 / $2,310.75 / $3,178.82
| Facility | | $1,612.95 | $2,310.75 | $3,178.82 |
- 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 |