- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.21 / $733.48 / $2,006.04
| Professional | | $454.21 | $733.48 | $2,006.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.07 / $1,213.54 / $7,896.02
| Facility | | $777.07 | $1,213.54 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.46 / $1,293.35 / $2,961.89
| Facility | | $910.46 | $1,293.35 | $2,961.89 |
- 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 |