- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.04 / $958.60 / $2,326.46
| Professional | | $600.04 | $958.60 | $2,326.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.69 / $1,498.83 / $8,604.00
| Facility | | $974.69 | $1,498.83 | $8,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.06 / $1,469.65 / $1,922.21
| Facility | | $1,164.06 | $1,469.65 | $1,922.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |