- 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
- $1,027.70 / $1,744.21 / $3,421.03
| Professional | | $1,027.70 | $1,744.21 | $3,421.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,765.92 / $2,793.88 / $7,305.00
| Facility | | $1,765.92 | $2,793.88 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.20 / $2,522.34 / $3,263.15
| Facility | | $1,687.20 | $2,522.34 | $3,263.15 |
- 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 |