- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,119.04
| Facility | | $3,496.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.84 / $2,346.67 / $4,229.37
| Professional | | $1,395.84 | $2,346.67 | $4,229.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.42 / $3,079.40 / $5,213.37
| Facility | | $2,021.42 | $3,079.40 | $5,213.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.31 / $3,296.18 / $4,659.39
| Facility | | $2,312.31 | $3,296.18 | $4,659.39 |
- 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 |