- 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
- $951.91 / $1,546.30 / $2,609.11
| Professional | | $951.91 | $1,546.30 | $2,609.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,765.36 / $2,373.62 / $6,608.00
| Facility | | $1,765.36 | $2,373.62 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.05 / $2,238.16 / $2,927.37
| Facility | | $1,503.05 | $2,238.16 | $2,927.37 |
- 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 |