- 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
- $302.20 / $511.69 / $1,082.70
| Professional | | $302.20 | $511.69 | $1,082.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.67 / $727.85 / $1,966.00
| Facility | | $449.67 | $727.85 | $1,966.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.60 / $727.85 / $1,013.64
| Facility | | $490.60 | $727.85 | $1,013.64 |
- 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 |