- 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
- $191.15 / $548.96 / $1,220.30
| Professional | | $191.15 | $548.96 | $1,220.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.72 / $709.24 / $3,028.08
| Facility | | $285.72 | $709.24 | $3,028.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.85 / $1,010.03 / $1,193.67
| Facility | | $418.85 | $1,010.03 | $1,193.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,559.00 / $4,878.97 / $7,305.00
| Facility | | $2,559.00 | $4,878.97 | $7,305.00 |