- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,817.59 / $7,943.37
| Facility | | $4,693.00 | $5,817.59 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.88 / $1,210.71 / $2,771.40
| Professional | | $731.88 | $1,210.71 | $2,771.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.50 / $1,878.72 / $11,495.00
| Facility | | $1,126.50 | $1,878.72 | $11,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.00 / $2,076.02 / $5,383.60
| Facility | | $1,332.00 | $2,076.02 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $7,487.00 / $11,732.00
| Facility | | $1,770.00 | $7,487.00 | $11,732.00 |