- 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
- $376.61 / $593.37 / $1,333.38
| Professional | | $376.61 | $593.37 | $1,333.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.53 / $1,064.28 / $7,123.00
| Facility | | $623.53 | $1,064.28 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.00 / $1,068.98 / $2,961.89
| Facility | | $786.00 | $1,068.98 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |