- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,772.37 / $19,054.61
| Facility | | $7,413.10 | $9,772.37 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $8,709.64
| Facility | | $407.38 | $707.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,000.00 / $1,348.96
| Professional | | $851.14 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,456.54 / $8,912.51
| Facility | | $4,073.80 | $6,456.54 | $8,912.51 |