- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $10,000.00 / $18,197.01
| Facility | | $2,238.72 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $9,332.54 / $17,782.79
| Facility | | $645.65 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,479.11
| Facility | | $891.25 | $891.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $2,041.74
| Professional | | $1,380.38 | $1,380.38 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $1,905.46
| Facility | | $831.76 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $19,952.62 / $25,703.96
| Facility | | $4,677.35 | $19,952.62 | $25,703.96 |