- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $4,964.00 / $7,120.36
| Facility | | $4,146.00 | $4,964.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.67 / $892.29 / $2,423.13
| Professional | | $580.67 | $892.29 | $2,423.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.21 / $1,571.08 / $7,123.00
| Facility | | $960.21 | $1,571.08 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $1,583.01 / $2,961.89
| Facility | | $1,189.00 | $1,583.01 | $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 |