- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.35 / $287.83 / $524.09
| Professional | | $167.35 | $287.83 | $524.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.27 / $473.63 / $1,775.00
| Facility | | $307.27 | $473.63 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.16 / $419.04 / $539.91
| Facility | | $279.16 | $419.04 | $539.91 |
- 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 |