- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.30 / $5,087.70 / $16,220.41
| Facility | | $1,572.30 | $5,087.70 | $16,220.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.00 / $657.42 / $676.96
| Professional | | $601.00 | $657.42 | $676.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.08 / $784.97 / $1,231.28
| Professional | | $546.08 | $784.97 | $1,231.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,540.96 / $4,515.88 / $10,616.93
| Facility | | $2,540.96 | $4,515.88 | $10,616.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.79 / $641.95 / $1,461.63
| Professional | | $503.79 | $641.95 | $1,461.63 |