- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,119.04
| Facility | | $3,496.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.14 / $5,147.72 / $6,417.95
| Professional | | $487.14 | $5,147.72 | $6,417.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.37 / $7,015.92 / $11,962.87
| Facility | | $732.37 | $7,015.92 | $11,962.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.43 / $6,853.21 / $11,962.87
| Facility | | $1,052.43 | $6,853.21 | $11,962.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $9,082.00 / $13,476.00
| Facility | | $1,770.00 | $9,082.00 | $13,476.00 |