- 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
- $1,460.92 / $2,444.08 / $4,090.59
| Professional | | $1,460.92 | $2,444.08 | $4,090.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,590.23 / $3,647.92 / $6,608.00
| Facility | | $2,590.23 | $3,647.92 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,307.48 / $3,463.18 / $4,529.62
| Facility | | $2,307.48 | $3,463.18 | $4,529.62 |
- 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 |