- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $10,000.00 / $18,197.01
| Facility | | $2,511.89 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $9,332.54 / $17,782.79
| Facility | | $1,380.38 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,621.81
| Facility | | $891.25 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $2,187.76
| Professional | | $1,380.38 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $2,089.30
| Facility | | $933.25 | $1,202.26 | $2,089.30 |
- 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 |