- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,365.16 / $6,918.31
| Facility | | $1,348.96 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $17,378.01
| Facility | | $7,943.28 | $13,182.57 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Facility | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $1,000.00 / $10,964.78
| Professional | | $12.59 | $1,000.00 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $12,022.64
| Facility | | $2,951.21 | $4,677.35 | $12,022.64 |