- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $1,768.00 / $4,100.00
| Facility | | $1,100.00 | $1,768.00 | $4,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.83 / $1,394.04 / $1,562.21
| Professional | | $1,354.83 | $1,394.04 | $1,562.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,455.92 / $16,329.40 / $21,968.27
| Facility | | $13,455.92 | $16,329.40 | $21,968.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,654.00 / $10,048.00 / $10,551.00
| Facility | | $4,654.00 | $10,048.00 | $10,551.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $5,201.00
| Facility | | $650.00 | $1,754.00 | $5,201.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.32 / $2,015.77 / $3,071.58
| Professional | | $1,467.32 | $2,015.77 | $3,071.58 |