- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,943.28 / $16,595.87
| Facility | | $1,318.26 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,897.79 / $9,120.11
| Facility | | $2,754.23 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,621.81
| Facility | | $575.44 | $575.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $2,041.74
| Facility | | $1,122.02 | $1,412.54 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,000.00
| Facility | | $1,698.24 | $6,760.83 | $10,000.00 |