- 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
- $1,786.29 / $2,968.17 / $4,767.37
| Professional | | $1,786.29 | $2,968.17 | $4,767.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.00 / $4,377.45 / $6,608.00
| Facility | | $2,950.00 | $4,377.45 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,738.21 / $4,106.06 / $5,370.45
| Facility | | $2,738.21 | $4,106.06 | $5,370.45 |
- 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 |