- 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
- $292.30 / $434.52 / $1,312.41
| Professional | | $292.30 | $434.52 | $1,312.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.27 / $779.97 / $3,590.15
| Facility | | $384.27 | $779.97 | $3,590.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.72 / $935.25 / $1,193.67
| Facility | | $557.72 | $935.25 | $1,193.67 |
- 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 |