- 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
- $887.74 / $1,359.81 / $2,991.00
| Professional | | $887.74 | $1,359.81 | $2,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.55 / $2,342.55 / $14,242.22
| Facility | | $1,076.55 | $2,342.55 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,675.59 / $2,539.15 / $8,919.81
| Facility | | $1,675.59 | $2,539.15 | $8,919.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,234.00 / $10,188.00 / $14,287.46
| Facility | | $7,234.00 | $10,188.00 | $14,287.46 |