- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,133.00 / $5,503.00 / $10,651.00
| Facility | | $3,133.00 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,973.52 / $3,189.00 / $4,605.30
| Professional | | $1,973.52 | $3,189.00 | $4,605.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $4,974.00 / $26,120.00
| Facility | | $2,285.00 | $4,974.00 | $26,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.00 / $2,537.00 / $3,847.00
| Facility | | $1,261.00 | $2,537.00 | $3,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.30 / $850.30 / $850.30
| Professional | | $850.30 | $850.30 | $850.30 |