- 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
- $534.60 / $851.13 / $1,433.00
| Professional | | $534.60 | $851.13 | $1,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.84 / $1,383.20 / $5,847.00
| Facility | | $742.84 | $1,383.20 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.96 / $1,280.93 / $1,705.29
| Facility | | $851.96 | $1,280.93 | $1,705.29 |
- 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 |