- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $10,000.00 / $18,197.01
| Facility | | $1,548.82 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,332.54 / $17,378.01
| Facility | | $3,981.07 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $2,290.87
| Facility | | $812.83 | $977.24 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $1,318.26
| Professional | | $758.58 | $758.58 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $707.95 / $1,258.93
| Facility | | $562.34 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $16,982.44 / $25,703.96
| Facility | | $3,630.78 | $16,982.44 | $25,703.96 |