- 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
- $376.31 / $536.97 / $1,153.40
| Professional | | $376.31 | $536.97 | $1,153.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.77 / $1,143.34 / $6,173.85
| Facility | | $616.77 | $1,143.34 | $6,173.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,187.08 / $2,428.62
| Facility | | $646.00 | $1,187.08 | $2,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |