- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,251.69 / $3,642.54 / $7,376.28
| Professional | | $2,251.69 | $3,642.54 | $7,376.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.00 / $5,244.00 / $6,833.29
| Facility | | $2,975.00 | $5,244.00 | $6,833.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,229.89 / $5,358.04 / $6,944.01
| Facility | | $4,229.89 | $5,358.04 | $6,944.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,856.00
| Facility | | $2,126.00 | $5,847.00 | $7,856.00 |