- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,702.26 / $4,098.16 / $10,979.97
| Professional | | $2,702.26 | $4,098.16 | $10,979.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.89 / $5,623.48 / $8,017.81
| Facility | | $3,293.89 | $5,623.48 | $8,017.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,665.96 / $6,462.11 / $9,099.01
| Facility | | $4,665.96 | $6,462.11 | $9,099.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |