- 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
- $1,831.23 / $2,571.62 / $3,580.49
| Professional | | $1,831.23 | $2,571.62 | $3,580.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.65 / $4,514.12 / $7,305.00
| Facility | | $1,969.65 | $4,514.12 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,305.10 / $4,304.93 / $5,834.28
| Facility | | $2,305.10 | $4,304.93 | $5,834.28 |
- 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 |