- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.65 / $1,916.33 / $4,030.62
| Professional | | $1,238.65 | $1,916.33 | $4,030.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.41 / $3,031.13 / $6,608.00
| Facility | | $1,658.41 | $3,031.13 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.85 / $2,665.35 / $3,546.20
| Facility | | $1,802.85 | $2,665.35 | $3,546.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |