- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.51 / $1,277.78 / $2,143.82
| Professional | | $775.51 | $1,277.78 | $2,143.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.15 / $2,245.86 / $15,214.55
| Facility | | $1,115.15 | $2,245.86 | $15,214.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,363.00 / $2,480.48 / $4,945.14
| Facility | | $1,363.00 | $2,480.48 | $4,945.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |