- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.11 / $373.38 / $1,035.45
| Professional | | $250.11 | $373.38 | $1,035.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.70 / $653.34 / $9,399.00
| Facility | | $320.70 | $653.34 | $9,399.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.65 / $766.78 / $3,170.91
| Facility | | $469.65 | $766.78 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |