- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $10,000.00 / $18,197.01
| Facility | | $1,905.46 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $10,715.19 / $19,952.62
| Facility | | $4,786.30 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $16,595.87
| Facility | | $812.83 | $1,174.90 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,548.82
| Professional | | $1,148.15 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $1,513.56
| Facility | | $676.08 | $954.99 | $1,513.56 |
- 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 |