- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $6,456.54 / $12,589.25
| Facility | | $1,000.00 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,623.41 / $10,964.78
| Facility | | $4,265.80 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $7,762.47
| Facility | | $457.09 | $794.33 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $1,548.82
| Professional | | $954.99 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,897.79 / $8,128.31
| Facility | | $3,630.78 | $4,897.79 | $8,128.31 |