- 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
- $584.38 / $898.31 / $1,501.09
| Professional | | $584.38 | $898.31 | $1,501.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.31 / $1,614.83 / $7,305.00
| Facility | | $829.31 | $1,614.83 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,802.85 / $2,403.80
| Facility | | $956.00 | $1,802.85 | $2,403.80 |
- 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 |