- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.46 / $1,474.18 / $2,492.53
| Professional | | $851.46 | $1,474.18 | $2,492.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.71 / $2,629.78 / $14,396.24
| Facility | | $1,557.71 | $2,629.78 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.00 / $2,803.26 / $5,383.60
| Facility | | $1,552.00 | $2,803.26 | $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 |