- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,570.88 / $9,772.37
| Facility | | $1,148.15 | $4,570.88 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $40,738.03 / $77,624.71
| Facility | | $15,135.61 | $40,738.03 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,981.07 / $13,182.57
| Professional | | $2,454.71 | $3,981.07 | $13,182.57 |
- 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
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |