- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,977.00 / $4,778.89 / $7,119.04
| Facility | | $2,977.00 | $4,778.89 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.68 / $490.93 / $1,395.71
| Professional | | $209.68 | $490.93 | $1,395.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.33 / $550.79 / $3,162.53
| Facility | | $273.33 | $550.79 | $3,162.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.10 / $622.80 / $3,033.31
| Facility | | $398.10 | $622.80 | $3,033.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $10,320.00 / $11,051.00
| Facility | | $5,341.00 | $10,320.00 | $11,051.00 |