- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,918.31 / $11,481.54
| Facility | | $1,659.59 | $6,918.31 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $7,244.36
| Facility | | $5,011.87 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $2,511.89
| Professional | | $1,737.80 | $1,737.80 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $2,238.72
| Facility | | $1,071.52 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $18,620.87
| Facility | | $4,466.84 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $16,595.87 / $16,595.87
| Facility | | $1,995.26 | $16,595.87 | $16,595.87 |