- 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
- $94.38 / $1,194.77 / $1,973.61
| Professional | | $94.38 | $1,194.77 | $1,973.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.91 / $1,372.50 / $4,663.00
| Facility | | $140.91 | $1,372.50 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.01 / $1,512.26 / $2,368.85
| Facility | | $208.01 | $1,512.26 | $2,368.85 |
- 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 |