- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,098.00 / $11,100.08
| Facility | | $4,964.00 | $6,098.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.08 / $1,835.46 / $3,545.60
| Professional | | $1,166.08 | $1,835.46 | $3,545.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.80 / $2,804.86 / $7,305.00
| Facility | | $1,473.80 | $2,804.86 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.48 / $2,771.90 / $3,790.72
| Facility | | $2,207.48 | $2,771.90 | $3,790.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |