- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,463.36 / $7,120.36
| Facility | | $4,146.00 | $5,463.36 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.61 / $1,640.13 / $5,970.45
| Professional | | $1,004.61 | $1,640.13 | $5,970.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.09 / $2,737.71 / $11,869.99
| Facility | | $1,685.09 | $2,737.71 | $11,869.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,957.58 / $2,598.69 / $5,383.60
| Facility | | $1,957.58 | $2,598.69 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |