- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,570.40 / $11,481.54
| Facility | | $1,000.00 | $2,570.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,698.24
| Professional | | $1,202.26 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,412.54
| Facility | | $691.83 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $14,454.40
| Facility | | $2,454.71 | $9,332.54 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $42,657.95
| Facility | | $8,912.51 | $8,912.51 | $42,657.95 |