- 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
- $345.49 / $493.37 / $811.85
| Professional | | $345.49 | $493.37 | $811.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.85 / $1,053.27 / $5,678.23
| Facility | | $535.85 | $1,053.27 | $5,678.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,094.25 / $2,428.62
| Facility | | $646.00 | $1,094.25 | $2,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,623.00 / $2,126.00
| Facility | | $1,204.00 | $1,623.00 | $2,126.00 |