- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,960.00 / $11,611.47
| Facility | | $4,964.00 | $6,960.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.17 / $1,482.83 / $2,577.12
| Professional | | $855.17 | $1,482.83 | $2,577.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.19 / $2,560.51 / $14,396.24
| Facility | | $1,547.19 | $2,560.51 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.00 / $2,859.98 / $5,383.60
| Facility | | $1,600.00 | $2,859.98 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |