- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.14 / $93.21 / $265.45
| Professional | | $62.14 | $93.21 | $265.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.08 / $119.17 / $1,623.00
| Facility | | $78.08 | $119.17 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.31 / $135.07 / $199.20
| Facility | | $107.31 | $135.07 | $199.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |