- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,120.11 / $16,595.87
| Facility | | $2,238.72 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $18,197.01
| Facility | | $4,897.79 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $7,585.78
| Facility | | $575.44 | $891.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,995.26
| Professional | | $1,174.90 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $1,862.09
| Facility | | $831.76 | $1,096.48 | $1,862.09 |
- 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 |