- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $9,120.11 / $18,197.01
| Facility | | $1,621.81 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,000.00 / $18,620.87
| Facility | | $4,265.80 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,047.13 / $2,570.40
| Facility | | $812.83 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,445.44
| Professional | | $1,000.00 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,348.96
| Facility | | $602.56 | $812.83 | $1,348.96 |
- 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 |