- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,456.54 / $6,456.54
| Facility | | $1,737.80 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $13,182.57
| Facility | | $5,011.87 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,248.07 / $8,511.38
| Facility | | $4,570.88 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,630.78 / $5,754.40
| Facility | | $1,737.80 | $3,630.78 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,801.89 / $8,317.64
| Facility | | $1,778.28 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,981.07 / $6,025.60
| Professional | | $2,570.40 | $3,981.07 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $22,908.68
| Facility | | $2,454.71 | $4,570.88 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |