- 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
- $908.43 / $1,613.87 / $2,509.03
| Professional | | $908.43 | $1,613.87 | $2,509.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.28 / $2,309.55 / $6,608.00
| Facility | | $1,716.28 | $2,309.55 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.15 / $2,170.87 / $2,792.16
| Facility | | $1,489.15 | $2,170.87 | $2,792.16 |
- 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 |