- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,119.04 / $11,611.47
| Facility | | $5,091.00 | $7,119.04 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.85 / $1,619.84 / $2,738.06
| Professional | | $938.85 | $1,619.84 | $2,738.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,838.92 / $2,903.10 / $14,396.24
| Facility | | $1,838.92 | $2,903.10 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.00 / $3,095.61 / $5,383.60
| Facility | | $1,705.00 | $3,095.61 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |