- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,795.64 / $7,119.04
| Facility | | $2,218.00 | $3,795.64 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.07 / $959.28 / $2,114.61
| Professional | | $621.07 | $959.28 | $2,114.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.51 / $1,654.68 / $7,123.00
| Facility | | $865.51 | $1,654.68 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.00 / $1,672.26 / $2,961.89
| Facility | | $1,136.00 | $1,672.26 | $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 |