- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,466.84 / $14,125.38
| Facility | | $1,318.26 | $4,466.84 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $20,892.96 / $29,512.09
| Facility | | $14,791.08 | $20,892.96 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,089.30 / $7,244.36
| Professional | | $1,122.02 | $2,089.30 | $7,244.36 |
- 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
- $2,570.40 / $7,943.28 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |