- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.66 / $601.22 / $1,174.55
| Professional | | $301.66 | $601.22 | $1,174.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.28 / $914.14 / $5,023.00
| Facility | | $485.28 | $914.14 | $5,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.80 / $1,081.20 / $1,913.58
| Facility | | $719.80 | $1,081.20 | $1,913.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |