- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,999.87 / $4,527.68 / $10,884.61
| Professional | | $2,999.87 | $4,527.68 | $10,884.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,821.10 / $6,234.30 / $8,621.92
| Facility | | $3,821.10 | $6,234.30 | $8,621.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,671.00 / $7,044.35 / $9,522.40
| Facility | | $4,671.00 | $7,044.35 | $9,522.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |