- 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
- $715.93 / $1,202.22 / $2,015.89
| Professional | | $715.93 | $1,202.22 | $2,015.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.58 / $1,965.97 / $7,393.10
| Facility | | $1,018.58 | $1,965.97 | $7,393.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.67 / $1,762.00 / $2,327.48
| Facility | | $1,175.67 | $1,762.00 | $2,327.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,360.50 / $6,036.00 / $10,320.00
| Facility | | $3,360.50 | $6,036.00 | $10,320.00 |