- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.30 / $1,370.51 / $3,073.00
| Professional | | $910.30 | $1,370.51 | $3,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.07 / $2,220.94 / $8,571.40
| Facility | | $1,033.07 | $2,220.94 | $8,571.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.00 / $2,205.23 / $3,036.55
| Facility | | $1,539.00 | $2,205.23 | $3,036.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $5,327.00 / $8,342.00
| Facility | | $1,770.00 | $5,327.00 | $8,342.00 |