- 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
- $843.68 / $1,384.85 / $2,076.71
| Professional | | $843.68 | $1,384.85 | $2,076.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.52 / $2,154.88 / $6,608.00
| Facility | | $1,421.52 | $2,154.88 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.98 / $1,943.22 / $2,541.58
| Facility | | $1,309.98 | $1,943.22 | $2,541.58 |
- 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 |