- 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
- $1,381.96 / $2,398.38 / $4,084.52
| Professional | | $1,381.96 | $2,398.38 | $4,084.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,065.30 / $3,151.60 / $6,608.00
| Facility | | $2,065.30 | $3,151.60 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.48 / $3,254.06 / $4,246.25
| Facility | | $2,143.48 | $3,254.06 | $4,246.25 |
- 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 |