- 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
- $326.73 / $4,418.72 / $6,260.97
| Professional | | $326.73 | $4,418.72 | $6,260.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.67 / $8,429.04 / $14,242.22
| Facility | | $859.67 | $8,429.04 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $823.59 / $5,266.71 / $11,531.91
| Facility | | $823.59 | $5,266.71 | $11,531.91 |
- 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 |