- 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
- $1,023.38 / $1,649.00 / $3,569.18
| Professional | | $1,023.38 | $1,649.00 | $3,569.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,344.76 / $2,388.04 / $4,663.00
| Facility | | $1,344.76 | $2,388.04 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.28 / $2,491.96 / $3,320.58
| Facility | | $1,690.28 | $2,491.96 | $3,320.58 |
- 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 |