- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,389.44 / $3,666.78 / $6,446.00
| Facility | | $2,389.44 | $3,666.78 | $6,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.51 / $1,173.32 / $1,952.96
| Professional | | $687.51 | $1,173.32 | $1,952.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.29 / $1,958.45 / $19,496.28
| Facility | | $1,375.29 | $1,958.45 | $19,496.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.51 / $1,646.96 / $2,250.59
| Facility | | $1,142.51 | $1,646.96 | $2,250.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |