- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.51 / $740.01 / $1,272.05
| Professional | | $430.51 | $740.01 | $1,272.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.18 / $1,234.61 / $8,586.74
| Facility | | $692.18 | $1,234.61 | $8,586.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.00 / $1,421.89 / $3,170.91
| Facility | | $812.00 | $1,421.89 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |