- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $3,259.25 / $7,119.04
| Facility | | $1,300.00 | $3,259.25 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.39 / $964.50 / $1,563.13
| Professional | | $115.39 | $964.50 | $1,563.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.89 / $1,421.67 / $2,135.86
| Facility | | $284.89 | $1,421.67 | $2,135.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.89 / $1,541.00 / $2,135.86
| Facility | | $284.89 | $1,541.00 | $2,135.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |