- 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
- $1,263.68 / $2,170.61 / $3,692.36
| Professional | | $1,263.68 | $2,170.61 | $3,692.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.05 / $3,826.36 / $14,396.24
| Facility | | $2,045.05 | $3,826.36 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.00 / $3,826.36 / $5,383.60
| Facility | | $2,299.00 | $3,826.36 | $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 |