- 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
- $1,454.87 / $2,339.81 / $3,937.50
| Professional | | $1,454.87 | $2,339.81 | $3,937.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.80 / $2,959.39 / $4,663.00
| Facility | | $1,655.80 | $2,959.39 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,414.00 / $3,531.26 / $4,766.38
| Facility | | $2,414.00 | $3,531.26 | $4,766.38 |
- 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 |