- 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
- $465.94 / $740.58 / $2,057.67
| Professional | | $465.94 | $740.58 | $2,057.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.57 / $1,222.79 / $7,896.02
| Facility | | $713.57 | $1,222.79 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.23 / $1,316.00 / $2,961.89
| Facility | | $927.23 | $1,316.00 | $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 |