- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,792.65 / $2,804.31 / $7,793.00
| Professional | | $1,792.65 | $2,804.31 | $7,793.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.52 / $4,063.14 / $5,396.23
| Facility | | $2,326.52 | $4,063.14 | $5,396.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.00 / $4,240.87 / $5,780.41
| Facility | | $2,867.00 | $4,240.87 | $5,780.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |