- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,463.36 / $8,626.20
| Facility | | $4,146.00 | $5,463.36 | $8,626.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.55 / $983.38 / $2,977.94
| Professional | | $605.55 | $983.38 | $2,977.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.36 / $1,608.73 / $7,896.02
| Facility | | $1,029.36 | $1,608.73 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.28 / $1,608.73 / $2,961.89
| Facility | | $1,204.28 | $1,608.73 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,154.93 / $3,154.93 / $3,154.93
| Facility | | $3,154.93 | $3,154.93 | $3,154.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |