- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,165.95 / $10,000.00
| Facility | | $1,659.59 | $6,165.95 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $7,585.78
| Facility | | $2,951.21 | $3,715.35 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $6,456.54
| Facility | | $346.74 | $562.34 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,000.00
| Professional | | $630.96 | $741.31 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $7,079.46
| Facility | | $6,025.60 | $6,025.60 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,365.16 / $8,128.31
| Facility | | $1,995.26 | $4,365.16 | $8,128.31 |