- 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
- $397.17 / $609.47 / $1,265.27
| Professional | | $397.17 | $609.47 | $1,265.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.23 / $1,023.94 / $5,301.00
| Facility | | $513.23 | $1,023.94 | $5,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.23 / $1,073.46 / $1,750.65
| Facility | | $789.23 | $1,073.46 | $1,750.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |