- 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
- $1,169.82 / $1,795.60 / $4,057.03
| Professional | | $1,169.82 | $1,795.60 | $4,057.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.82 / $2,796.19 / $5,321.00
| Facility | | $1,547.82 | $2,796.19 | $5,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.90 / $2,796.19 / $3,781.22
| Facility | | $2,311.90 | $2,796.19 | $3,781.22 |
- 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 |