- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,100.08 / $20,928.72
| Facility | | $5,463.36 | $11,100.08 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $1,556.10 / $12,765.09
| Professional | | $1,161.00 | $1,556.10 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.14 / $781.45 / $1,511.58
| Facility | | $594.14 | $781.45 | $1,511.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.86 / $1,775.00 / $6,169.00
| Facility | | $875.86 | $1,775.00 | $6,169.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,562.00 / $2,743.00 / $6,043.00
| Facility | | $1,562.00 | $2,743.00 | $6,043.00 |