- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $6,298.62 / $12,885.00
| Facility | | $3,496.00 | $6,298.62 | $12,885.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.81 / $363.75 / $930.56
| Professional | | $234.81 | $363.75 | $930.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.89 / $582.28 / $7,123.00
| Facility | | $301.89 | $582.28 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.37 / $555.51 / $752.95
| Facility | | $412.37 | $555.51 | $752.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |