- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,778.89 / $7,119.04
| Facility | | $2,906.00 | $4,778.89 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.06 / $1,327.94 / $2,425.32
| Professional | | $866.06 | $1,327.94 | $2,425.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.36 / $2,096.96 / $7,042.90
| Facility | | $1,106.36 | $2,096.96 | $7,042.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.00 / $2,225.94 / $2,803.13
| Facility | | $1,428.00 | $2,225.94 | $2,803.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $6,588.00 / $10,320.00
| Facility | | $1,770.00 | $6,588.00 | $10,320.00 |