- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $8,750.66
| Facility | | $4,146.00 | $5,091.00 | $8,750.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.58 / $1,464.42 / $3,113.30
| Professional | | $945.58 | $1,464.42 | $3,113.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.12 / $2,439.09 / $11,139.12
| Facility | | $1,373.12 | $2,439.09 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $2,560.19 / $6,616.19
| Facility | | $1,794.00 | $2,560.19 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |