- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,187.76 / $7,943.28
| Facility | | $1,318.26 | $2,187.76 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $2,089.30
| Professional | | $1,258.93 | $1,737.80 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,202.26 / $2,089.30
| Facility | | $870.96 | $1,202.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $1,778.28
| Facility | | $1,230.27 | $1,698.24 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $2,041.74
| Facility | | $812.83 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |