- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $7,943.37
| Facility | | $4,693.00 | $5,549.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.94 / $2,083.98 / $5,258.51
| Professional | | $1,364.94 | $2,083.98 | $5,258.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,923.93 / $3,251.44 / $14,479.00
| Facility | | $1,923.93 | $3,251.44 | $14,479.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $3,200.63 / $4,026.49
| Facility | | $2,393.00 | $3,200.63 | $4,026.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |