- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,917.20 / $7,119.04
| Facility | | $3,496.00 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.22 / $789.35 / $1,335.42
| Professional | | $427.22 | $789.35 | $1,335.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.69 / $1,182.04 / $5,567.24
| Facility | | $687.69 | $1,182.04 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.42 / $1,440.38 / $2,932.27
| Facility | | $949.42 | $1,440.38 | $2,932.27 |
- 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 |