- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $3,795.64 / $7,119.04
| Facility | | $2,234.00 | $3,795.64 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.69 / $216.83 / $432.24
| Professional | | $143.69 | $216.83 | $432.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.19 / $345.41 / $4,871.77
| Facility | | $157.19 | $345.41 | $4,871.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.54 / $466.63 / $1,622.05
| Facility | | $248.54 | $466.63 | $1,622.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |