- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,677.35 / $10,471.29
| Facility | | $1,659.59 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,570.88
| Facility | | $4,466.84 | $4,466.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,818.38
| Professional | | $2,238.72 | $2,238.72 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,659.59 / $2,630.27
| Facility | | $1,202.26 | $1,659.59 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $15,488.17 / $22,908.68
| Facility | | $6,025.60 | $15,488.17 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $79,432.82 / $79,432.82
| Facility | | $33,884.42 | $79,432.82 | $79,432.82 |