- 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
- $2,426.71 / $4,028.34 / $6,760.56
| Professional | | $2,426.71 | $4,028.34 | $6,760.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,474.23 / $5,799.04 / $7,305.00
| Facility | | $3,474.23 | $5,799.04 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,744.08 / $5,682.84 / $7,262.31
| Facility | | $3,744.08 | $5,682.84 | $7,262.31 |
- 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 |