- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,083.84 / $3,299.60 / $4,204.85
| Professional | | $2,083.84 | $3,299.60 | $4,204.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.30 / $4,211.06 / $6,608.00
| Facility | | $1,433.30 | $4,211.06 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,486.03 / $5,215.20 / $7,004.72
| Facility | | $3,486.03 | $5,215.20 | $7,004.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |