- 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
- $1,595.46 / $2,525.48 / $6,008.32
| Professional | | $1,595.46 | $2,525.48 | $6,008.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.10 / $4,043.22 / $7,305.00
| Facility | | $2,347.10 | $4,043.22 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,657.84 / $3,725.60 / $5,000.68
| Facility | | $2,657.84 | $3,725.60 | $5,000.68 |
- 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 |