- 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
- $794.04 / $1,317.30 / $2,315.51
| Professional | | $794.04 | $1,317.30 | $2,315.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.68 / $2,250.14 / $7,549.50
| Facility | | $1,503.68 | $2,250.14 | $7,549.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.40 / $1,874.07 / $2,620.64
| Facility | | $1,335.40 | $1,874.07 | $2,620.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |