- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,630.78 / $8,317.64
| Facility | | $1,071.52 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $2,511.89
| Professional | | $812.83 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,513.56 / $2,187.76
| Professional | | $1,202.26 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $1,995.26
| Facility | | $912.01 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $10,000.00
| Facility | | $870.96 | $1,258.93 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,748.98 / $23,988.33
| Facility | | $6,760.83 | $11,748.98 | $23,988.33 |