- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.20 / $1,201.67 / $2,018.86
| Professional | | $692.20 | $1,201.67 | $2,018.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.48 / $1,929.06 / $9,205.60
| Facility | | $1,080.48 | $1,929.06 | $9,205.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.02 / $1,680.57 / $2,278.75
| Facility | | $1,161.02 | $1,680.57 | $2,278.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |