- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $10,130.87
| Facility | | $4,146.00 | $5,091.00 | $10,130.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.26 / $1,382.75 / $2,579.19
| Professional | | $977.26 | $1,382.75 | $2,579.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.16 / $2,950.00 / $6,945.09
| Facility | | $1,445.16 | $2,950.00 | $6,945.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.19 / $2,185.76 / $2,889.59
| Facility | | $1,679.19 | $2,185.76 | $2,889.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |