- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.68 / $5,063.00 / $9,488.00
| Facility | | $1,442.68 | $5,063.00 | $9,488.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.31 / $5,656.86 / $12,326.53
| Facility | | $2,206.31 | $5,656.86 | $12,326.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.08 / $1,904.36 / $2,590.48
| Facility | | $1,584.08 | $1,904.36 | $2,590.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,028.58 / $2,500.00
| Facility | | $500.00 | $1,028.58 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.47 / $1,432.72 / $2,691.22
| Professional | | $994.47 | $1,432.72 | $2,691.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $6,351.00 / $8,836.00
| Facility | | $1,519.00 | $6,351.00 | $8,836.00 |