- 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
- $784.30 / $1,237.18 / $3,063.27
| Professional | | $784.30 | $1,237.18 | $3,063.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.24 / $1,831.07 / $5,327.00
| Facility | | $1,069.24 | $1,831.07 | $5,327.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.43 / $1,861.70 / $2,460.40
| Facility | | $1,250.43 | $1,861.70 | $2,460.40 |
- 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 |