- 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
- $416.74 / $657.59 / $1,848.47
| Professional | | $416.74 | $657.59 | $1,848.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.29 / $1,054.40 / $6,267.00
| Facility | | $621.29 | $1,054.40 | $6,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.92 / $1,150.77 / $2,961.89
| Facility | | $867.92 | $1,150.77 | $2,961.89 |
- 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 |