- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,918.31 / $14,454.40
| Facility | | $1,819.70 | $6,918.31 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,090.30 / $5,623.41
| Facility | | $501.19 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Professional | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $3,548.13
| Facility | | $1,584.89 | $2,137.96 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,025.60 / $16,982.44
| Facility | | $1,513.56 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $33,884.42
| Facility | | $16,982.44 | $16,982.44 | $33,884.42 |