- 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
- $178.53 / $267.62 / $661.57
| Professional | | $178.53 | $267.62 | $661.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.70 / $442.90 / $4,871.77
| Facility | | $203.70 | $442.90 | $4,871.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.10 / $579.29 / $1,622.05
| Facility | | $322.10 | $579.29 | $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 |