- 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
- $554.63 / $874.08 / $1,844.49
| Professional | | $554.63 | $874.08 | $1,844.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.69 / $1,379.14 / $4,645.00
| Facility | | $965.69 | $1,379.14 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.69 / $1,351.40 / $1,719.96
| Facility | | $1,105.69 | $1,351.40 | $1,719.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |