- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,454.71 / $5,011.87
| Facility | | $954.99 | $2,454.71 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $17,378.01 / $22,908.68
| Facility | | $11,748.98 | $17,378.01 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $43,651.58
| Professional | | $426.58 | $741.31 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $29,512.09 / $29,512.09
| Facility | | $29,512.09 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,332.54 / $51,286.14
| Facility | | $5,128.61 | $9,332.54 | $51,286.14 |