- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.55 / $1,790.78 / $4,157.72
| Professional | | $1,159.55 | $1,790.78 | $4,157.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,858.22 / $3,063.66 / $26,648.02
| Facility | | $1,858.22 | $3,063.66 | $26,648.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,256.94 / $3,013.38 / $25,369.85
| Facility | | $2,256.94 | $3,013.38 | $25,369.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |