- 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
- $1,259.41 / $2,036.25 / $3,431.80
| Professional | | $1,259.41 | $2,036.25 | $3,431.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.43 / $3,064.62 / $5,521.00
| Facility | | $1,770.43 | $3,064.62 | $5,521.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,061.42 / $2,980.33 / $4,042.65
| Facility | | $2,061.42 | $2,980.33 | $4,042.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |