- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $16,982.44
| Facility | | $2,511.89 | $6,456.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,548.13 / $9,332.54
| Facility | | $66.07 | $3,548.13 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,801.89
| Facility | | $3,162.28 | $3,162.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $1,258.93
| Professional | | $588.84 | $891.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $2,041.74
| Professional | | $812.83 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $28,840.32 / $28,840.32
| Facility | | $14,454.40 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,905.46
| Facility | | $1,000.00 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,000.00 / $20,892.96
| Facility | | $5,370.32 | $10,000.00 | $20,892.96 |