- 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
- $687.74 / $1,212.93 / $2,040.87
| Professional | | $687.74 | $1,212.93 | $2,040.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.08 / $1,722.23 / $4,110.10
| Facility | | $1,072.08 | $1,722.23 | $4,110.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.65 / $1,706.70 / $2,304.81
| Facility | | $1,349.65 | $1,706.70 | $2,304.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |