- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.00 / $4,955.00 / $10,651.00
| Facility | | $1,532.00 | $4,955.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.00 / $7,478.00 / $13,989.00
| Facility | | $4,427.00 | $7,478.00 | $13,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,261.85 / $2,261.85 / $7,124.94
| Facility | | $2,261.85 | $2,261.85 | $7,124.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.22 / $831.36 / $1,095.17
| Facility | | $644.22 | $831.36 | $1,095.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.62 / $924.87 / $1,275.68
| Professional | | $701.62 | $924.87 | $1,275.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,804.00 / $8,689.00 / $15,722.00
| Facility | | $3,804.00 | $8,689.00 | $15,722.00 |