- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.60 / $1,662.22 / $2,813.38
| Professional | | $972.60 | $1,662.22 | $2,813.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.53 / $3,003.88 / $14,396.24
| Facility | | $1,895.53 | $3,003.88 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.00 / $3,203.07 / $5,383.60
| Facility | | $1,756.00 | $3,203.07 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |