- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,928.85 / $3,977.00 / $8,133.00
| Facility | | $2,928.85 | $3,977.00 | $8,133.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,925.60 / $3,206.94 / $6,986.92
| Professional | | $1,925.60 | $3,206.94 | $6,986.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $60.00 / $767.42
| Professional | | $30.00 | $60.00 | $767.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,370.62 / $10,940.20 / $15,943.01
| Facility | | $8,370.62 | $10,940.20 | $15,943.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $7,693.00 / $13,847.00
| Facility | | $2,912.00 | $7,693.00 | $13,847.00 |