- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $13,803.84
| Facility | | $1,202.26 | $1,584.89 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,479.11
| Professional | | $912.01 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $1,513.56
| Facility | | $602.56 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $1,258.93
| Facility | | $1,000.00 | $1,174.90 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $1,445.44
| Facility | | $616.60 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $12,302.69
| Facility | | $7,762.47 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $12,882.50 / $26,302.68
| Facility | | $2,137.96 | $12,882.50 | $26,302.68 |