- 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
- $1,103.48 / $1,926.83 / $3,239.46
| Professional | | $1,103.48 | $1,926.83 | $3,239.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.05 / $3,416.64 / $14,396.24
| Facility | | $2,054.05 | $3,416.64 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,017.00 / $3,635.35 / $5,383.60
| Facility | | $2,017.00 | $3,635.35 | $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 |