- 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
- $404.67 / $642.17 / $1,692.22
| Professional | | $404.67 | $642.17 | $1,692.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $664.05 / $1,081.02 / $7,896.02
| Facility | | $664.05 | $1,081.02 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.17 / $1,148.84 / $2,961.89
| Facility | | $811.17 | $1,148.84 | $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 |