- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $4,964.00 / $9,185.68
| Facility | | $4,146.00 | $4,964.00 | $9,185.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.53 / $1,021.98 / $2,149.73
| Professional | | $611.53 | $1,021.98 | $2,149.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.71 / $2,385.60 / $37,391.55
| Facility | | $1,306.71 | $2,385.60 | $37,391.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.52 / $2,557.02 / $3,939.23
| Facility | | $1,310.52 | $2,557.02 | $3,939.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |