- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.08 / $2,912.34 / $6,446.00
| Facility | | $1,466.08 | $2,912.34 | $6,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.27 / $236.18 / $394.61
| Professional | | $77.27 | $236.18 | $394.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.58 / $369.72 / $4,663.00
| Facility | | $193.58 | $369.72 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.85 / $369.72 / $1,331.66
| Facility | | $204.85 | $369.72 | $1,331.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |