- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,073.80 / $8,511.38
| Facility | | $1,148.15 | $4,073.80 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $28,840.32 / $56,234.13
| Facility | | $10,715.19 | $28,840.32 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,548.13 / $10,000.00
| Professional | | $2,137.96 | $3,548.13 | $10,000.00 |
- 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 |