- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $3,795.64 / $7,119.04
| Facility | | $2,293.00 | $3,795.64 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $646.00 / $646.00
| Facility | | $646.00 | $646.00 | $646.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.84 / $1,026.73 / $2,442.00
| Professional | | $656.84 | $1,026.73 | $2,442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.03 / $1,597.20 / $7,155.00
| Facility | | $906.03 | $1,597.20 | $7,155.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.00 / $1,886.64 / $3,508.23
| Facility | | $1,102.00 | $1,886.64 | $3,508.23 |
- 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 |