- 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
- $895.25 / $1,367.65 / $2,247.61
| Professional | | $895.25 | $1,367.65 | $2,247.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.77 / $2,264.06 / $6,608.00
| Facility | | $1,592.77 | $2,264.06 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,402.48 / $2,131.71 / $2,811.38
| Facility | | $1,402.48 | $2,131.71 | $2,811.38 |
- 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 |