- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.81 / $1,062.41 / $2,848.18
| Professional | | $692.81 | $1,062.41 | $2,848.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.50 / $1,815.86 / $6,034.22
| Facility | | $1,130.50 | $1,815.86 | $6,034.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.00 / $1,802.85 / $2,285.90
| Facility | | $1,183.00 | $1,802.85 | $2,285.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,163.00 / $7,510.67
| Facility | | $3,044.00 | $5,163.00 | $7,510.67 |