- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,462.87 / $4,277.00 / $7,119.04
| Facility | | $3,462.87 | $4,277.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.83 / $558.30 / $905.42
| Professional | | $313.83 | $558.30 | $905.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.61 / $943.07 / $9,558.29
| Facility | | $641.61 | $943.07 | $9,558.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.00 / $1,031.43 / $3,162.53
| Facility | | $576.00 | $1,031.43 | $3,162.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |