- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $12,114.33
| Facility | | $3,496.00 | $5,091.00 | $12,114.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.03 / $714.06 / $1,348.40
| Professional | | $420.03 | $714.06 | $1,348.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.00 / $1,359.76 / $9,495.24
| Facility | | $846.00 | $1,359.76 | $9,495.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.00 / $1,365.24 / $3,018.60
| Facility | | $846.00 | $1,365.24 | $3,018.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |