- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,960.00 / $11,611.47
| Facility | | $4,964.00 | $6,960.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.86 / $1,117.26 / $1,941.61
| Professional | | $643.86 | $1,117.26 | $1,941.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.20 / $1,932.00 / $14,396.24
| Facility | | $1,165.20 | $1,932.00 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.00 / $2,155.30 / $5,383.60
| Facility | | $1,206.00 | $2,155.30 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |