- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.25 / $698.87 / $1,697.52
| Professional | | $440.25 | $698.87 | $1,697.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.79 / $1,158.08 / $7,896.02
| Facility | | $652.79 | $1,158.08 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.85 / $1,254.77 / $2,961.89
| Facility | | $882.85 | $1,254.77 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |