- 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
- $1,043.65 / $1,865.33 / $3,142.48
| Professional | | $1,043.65 | $1,865.33 | $3,142.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.07 / $3,132.18 / $14,396.24
| Facility | | $1,812.07 | $3,132.18 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.00 / $3,441.60 / $5,383.60
| Facility | | $1,937.00 | $3,441.60 | $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 |