- 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
- $150.86 / $627.52 / $1,192.50
| Professional | | $150.86 | $627.52 | $1,192.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.16 / $706.20 / $1,381.34
| Facility | | $227.16 | $706.20 | $1,381.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.20 / $854.84 / $1,412.51
| Facility | | $288.20 | $854.84 | $1,412.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,607.00 / $1,966.00
| Facility | | $1,026.00 | $1,607.00 | $1,966.00 |