- 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
- $925.38 / $1,526.94 / $2,360.46
| Professional | | $925.38 | $1,526.94 | $2,360.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.75 / $2,337.00 / $6,608.00
| Facility | | $1,615.75 | $2,337.00 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.31 / $2,118.23 / $2,770.53
| Facility | | $1,415.31 | $2,118.23 | $2,770.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $6,110.41 / $7,305.00
| Facility | | $2,126.00 | $6,110.41 | $7,305.00 |