- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $7,943.37
| Facility | | $4,693.00 | $5,549.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.61 / $1,025.64 / $2,662.80
| Professional | | $648.61 | $1,025.64 | $2,662.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.09 / $1,715.27 / $7,896.02
| Facility | | $1,068.09 | $1,715.27 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.93 / $1,777.30 / $2,961.89
| Facility | | $1,337.93 | $1,777.30 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.89 / $6,840.79 / $9,751.77
| Facility | | $4,180.89 | $6,840.79 | $9,751.77 |