- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.47 / $823.22 / $1,495.05
| Professional | | $529.47 | $823.22 | $1,495.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.00 / $1,749.40 / $6,306.00
| Facility | | $931.00 | $1,749.40 | $6,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.05 / $1,651.86 / $2,074.90
| Facility | | $1,176.05 | $1,651.86 | $2,074.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.00 / $5,854.53 / $7,407.10
| Facility | | $2,950.00 | $5,854.53 | $7,407.10 |