- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,244.36 / $16,595.87
| Facility | | $1,000.00 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,232.93 / $19,054.61
| Facility | | $4,265.80 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $7,943.28
| Facility | | $588.84 | $891.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Professional | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $4,677.35 / $9,772.37
| Facility | | $346.74 | $4,677.35 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |