- 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
- $2,695.17 / $4,432.35 / $7,275.37
| Professional | | $2,695.17 | $4,432.35 | $7,275.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,617.38 / $6,158.69 / $7,879.76
| Facility | | $3,617.38 | $6,158.69 | $7,879.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,176.39 / $6,257.87 / $8,184.87
| Facility | | $4,176.39 | $6,257.87 | $8,184.87 |
- 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 |