- 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
- $238.60 / $472.15 / $764.42
| Professional | | $238.60 | $472.15 | $764.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.93 / $759.33 / $1,607.00
| Facility | | $470.93 | $759.33 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.59 / $637.75 / $982.60
| Facility | | $439.59 | $637.75 | $982.60 |
- 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 |