- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.19 / $4,505.00 / $7,120.36
| Facility | | $1,064.19 | $4,505.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.44 / $584.04 / $1,066.75
| Professional | | $336.44 | $584.04 | $1,066.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.00 / $1,071.24 / $20,604.33
| Facility | | $676.00 | $1,071.24 | $20,604.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.00 / $1,092.30 / $11,805.10
| Facility | | $676.00 | $1,092.30 | $11,805.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |