- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.24 / $524.54 / $1,181.44
| Professional | | $337.24 | $524.54 | $1,181.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.59 / $16,167.00 / $57,645.35
| Facility | | $587.59 | $16,167.00 | $57,645.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.22 / $1,155.47 / $37,445.76
| Facility | | $762.22 | $1,155.47 | $37,445.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,237.00 / $25,438.00 / $65,894.00
| Facility | | $16,237.00 | $25,438.00 | $65,894.00 |