- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.00 / $5,405.00 / $7,421.00
| Facility | | $3,562.00 | $5,405.00 | $7,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,562.00 / $5,490.00 / $6,915.00
| Professional | | $3,562.00 | $5,490.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.27 / $3,801.18 / $7,114.08
| Facility | | $1,282.27 | $3,801.18 | $7,114.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.77 / $893.77 / $893.77
| Professional | | $870.77 | $893.77 | $893.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.00 / $7,362.00 / $18,000.00
| Facility | | $2,303.00 | $7,362.00 | $18,000.00 |