- 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
- $1,082.61 / $2,054.30 / $3,636.27
| Professional | | $1,082.61 | $2,054.30 | $3,636.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,164.40 / $2,921.71 / $6,608.00
| Facility | | $2,164.40 | $2,921.71 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.27 / $2,747.55 / $3,560.25
| Facility | | $1,824.27 | $2,747.55 | $3,560.25 |
- 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 |