- 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
- $615.94 / $961.16 / $1,859.79
| Professional | | $615.94 | $961.16 | $1,859.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.68 / $1,781.62 / $5,521.00
| Facility | | $902.68 | $1,781.62 | $5,521.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.00 / $1,579.55 / $2,085.58
| Facility | | $1,241.00 | $1,579.55 | $2,085.58 |
- 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 |