- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.03 / $706.86 / $1,213.13
| Professional | | $364.03 | $706.86 | $1,213.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.80 / $992.02 / $5,567.24
| Facility | | $586.80 | $992.02 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.94 / $1,164.47 / $2,932.27
| Facility | | $804.94 | $1,164.47 | $2,932.27 |
- 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 |