- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $8,709.64
| Facility | | $1,318.26 | $2,137.96 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $2,290.87
| Facility | | $489.78 | $575.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $2,754.23
| Facility | | $1,258.93 | $1,737.80 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,265.80 / $9,549.93
| Facility | | $912.01 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $16,982.44 / $16,982.44
| Facility | | $56.23 | $16,982.44 | $16,982.44 |