- 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
- $1,456.23 / $2,479.34 / $4,516.67
| Professional | | $1,456.23 | $2,479.34 | $4,516.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.06 / $3,722.32 / $7,305.00
| Facility | | $2,748.06 | $3,722.32 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.98 / $3,546.30 / $4,638.30
| Facility | | $2,368.98 | $3,546.30 | $4,638.30 |
- 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 |