- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.06 / $758.39 / $1,546.57
| Professional | | $477.06 | $758.39 | $1,546.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.46 / $1,276.01 / $7,123.00
| Facility | | $730.46 | $1,276.01 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,359.77 / $2,961.89
| Facility | | $953.00 | $1,359.77 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |