- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.48 / $1,168.05 / $2,828.64
| Professional | | $829.48 | $1,168.05 | $2,828.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.50 / $2,605.40 / $9,874.90
| Facility | | $1,358.50 | $2,605.40 | $9,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.00 / $2,380.56 / $3,123.31
| Facility | | $1,458.00 | $2,380.56 | $3,123.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |