- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $8,709.64
| Facility | | $1,000.00 | $2,187.76 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,479.11
| Professional | | $1,148.15 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,318.26
| Facility | | $630.96 | $870.96 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,748.98 / $18,620.87
| Facility | | $5,011.87 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $45,708.82
| Facility | | $19,952.62 | $19,952.62 | $45,708.82 |