- 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
- $750.24 / $1,217.65 / $2,043.26
| Professional | | $750.24 | $1,217.65 | $2,043.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.10 / $2,006.85 / $6,608.00
| Facility | | $1,059.10 | $2,006.85 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.32 / $1,778.74 / $2,414.56
| Facility | | $1,218.32 | $1,778.74 | $2,414.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |