- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,466.84 / $14,125.38
| Facility | | $1,148.15 | $4,466.84 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,511.38 / $14,454.40
| Facility | | $4,265.80 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $5,623.41
| Facility | | $912.01 | $1,148.15 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $4,897.79
| Professional | | $891.25 | $1,548.82 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,370.32 / $12,302.69
| Facility | | $1,905.46 | $5,370.32 | $12,302.69 |