- 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
- $1,823.06 / $3,522.86 / $5,654.04
| Professional | | $1,823.06 | $3,522.86 | $5,654.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.36 / $5,517.67 / $7,305.00
| Facility | | $2,550.36 | $5,517.67 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,658.45 / $5,252.51 / $7,110.64
| Facility | | $3,658.45 | $5,252.51 | $7,110.64 |
- 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 |