- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,960.00 / $11,611.47
| Facility | | $4,277.00 | $6,960.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.19 / $699.27 / $1,497.33
| Professional | | $441.19 | $699.27 | $1,497.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.80 / $1,175.41 / $7,123.00
| Facility | | $661.80 | $1,175.41 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.86 / $1,258.33 / $2,961.89
| Facility | | $891.86 | $1,258.33 | $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 |