- 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
- $1,166.01 / $1,971.69 / $3,402.79
| Professional | | $1,166.01 | $1,971.69 | $3,402.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,785.06 / $2,924.98 / $6,608.00
| Facility | | $1,785.06 | $2,924.98 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,964.54 / $2,751.16 / $3,847.01
| Facility | | $1,964.54 | $2,751.16 | $3,847.01 |
- 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 |