- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.64 / $1,088.57 / $2,331.77
| Professional | | $686.64 | $1,088.57 | $2,331.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.60 / $1,700.49 / $3,825.00
| Facility | | $1,072.60 | $1,700.49 | $3,825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.12 / $1,688.41 / $2,208.32
| Facility | | $1,325.12 | $1,688.41 | $2,208.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |