- 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
- $325.57 / $516.03 / $1,243.33
| Professional | | $325.57 | $516.03 | $1,243.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.46 / $865.30 / $4,324.56
| Facility | | $461.46 | $865.30 | $4,324.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.84 / $928.09 / $1,331.66
| Facility | | $655.84 | $928.09 | $1,331.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |