- 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
- $999.03 / $1,578.04 / $3,401.01
| Professional | | $999.03 | $1,578.04 | $3,401.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.74 / $2,298.34 / $4,663.00
| Facility | | $1,360.74 | $2,298.34 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.68 / $2,366.06 / $3,143.74
| Facility | | $1,593.68 | $2,366.06 | $3,143.74 |
- 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 |