- 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
- $533.37 / $816.17 / $1,652.50
| Professional | | $533.37 | $816.17 | $1,652.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.43 / $1,387.00 / $7,123.00
| Facility | | $658.43 | $1,387.00 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.13 / $1,521.34 / $2,961.89
| Facility | | $1,058.13 | $1,521.34 | $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 |