- 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
- $862.70 / $1,358.23 / $2,617.12
| Professional | | $862.70 | $1,358.23 | $2,617.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.00 / $1,987.44 / $4,663.00
| Facility | | $1,162.00 | $1,987.44 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.30 / $2,044.37 / $2,743.98
| Facility | | $1,386.30 | $2,044.37 | $2,743.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |