- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.67 / $5,463.36 / $9,248.33
| Facility | | $3,158.67 | $5,463.36 | $9,248.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.73 / $1,558.43 / $4,030.62
| Professional | | $977.73 | $1,558.43 | $4,030.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.46 / $2,594.81 / $14,242.22
| Facility | | $1,662.46 | $2,594.81 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.48 / $2,594.81 / $6,616.19
| Facility | | $1,940.48 | $2,594.81 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,577.51 / $7,577.51 / $7,577.51
| Facility | | $7,577.51 | $7,577.51 | $7,577.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |