- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $14,125.38 / $28,183.83
| Facility | | $4,265.80 | $14,125.38 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,709.64 / $20,892.96
| Facility | | $6,309.57 | $8,709.64 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,309.57 / $10,000.00
| Professional | | $4,897.79 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,187.76 / $6,456.54
| Facility | | $912.01 | $2,187.76 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,691.53 / $4,365.16
| Professional | | $1,949.84 | $2,691.53 | $4,365.16 |