- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.42 / $638.77 / $1,594.86
| Professional | | $362.42 | $638.77 | $1,594.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.29 / $1,037.43 / $8,586.74
| Facility | | $639.29 | $1,037.43 | $8,586.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,190.91 / $3,414.83
| Facility | | $773.00 | $1,190.91 | $3,414.83 |
- 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 |