- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.56 / $5,282.00 / $10,767.00
| Facility | | $1,289.56 | $5,282.00 | $10,767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.91 / $1,309.08 / $1,614.55
| Professional | | $1,090.91 | $1,309.08 | $1,614.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.74 / $1,544.05 / $2,291.71
| Facility | | $1,260.74 | $1,544.05 | $2,291.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.67 / $1,524.29 / $6,585.00
| Facility | | $1,162.67 | $1,524.29 | $6,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.00 / $11,671.00 / $21,639.00
| Facility | | $6,693.00 | $11,671.00 | $21,639.00 |