- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,736.00 / $4,736.00 / $6,907.00
| Facility | | $4,736.00 | $4,736.00 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.61 / $402.48 / $402.48
| Professional | | $319.61 | $402.48 | $402.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,480.70 / $5,480.70 / $5,480.70
| Facility | | $5,480.70 | $5,480.70 | $5,480.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,485.00
| Facility | | $1,000.00 | $1,000.00 | $1,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.80 / $607.26 / $1,146.39
| Professional | | $438.80 | $607.26 | $1,146.39 |