- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.64 / $5,091.00 / $7,119.04
| Facility | | $289.64 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.68 / $167.97 / $299.19
| Professional | | $96.68 | $167.97 | $299.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.45 / $261.82 / $1,775.00
| Facility | | $165.45 | $261.82 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.52 / $242.64 / $317.36
| Facility | | $159.52 | $242.64 | $317.36 |
- 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 |