- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.47 / $1,460.97 / $2,563.17
| Professional | | $796.47 | $1,460.97 | $2,563.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.48 / $2,143.98 / $6,608.00
| Facility | | $1,322.48 | $2,143.98 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.86 / $2,032.88 / $2,882.41
| Facility | | $1,470.86 | $2,032.88 | $2,882.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |