- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $3,784.48 / $7,920.26
| Facility | | $2,747.00 | $3,784.48 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,479.96 / $3,564.35 / $4,013.09
| Professional | | $2,479.96 | $3,564.35 | $4,013.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.31 / $3,121.21 / $4,393.12
| Facility | | $2,043.31 | $3,121.21 | $4,393.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.37 / $2,953.48 / $3,222.70
| Facility | | $2,184.37 | $2,953.48 | $3,222.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.31 / $3,405.18 / $4,362.35
| Facility | | $2,043.31 | $3,405.18 | $4,362.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,287.06 / $8,287.06 / $8,287.06
| Facility | | $8,287.06 | $8,287.06 | $8,287.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $5,130.00 / $7,385.00
| Facility | | $1,689.00 | $5,130.00 | $7,385.00 |