- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $10,000.00 / $20,417.38
| Facility | | $1,258.93 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,309.57 / $12,022.64
| Facility | | $2,754.23 | $6,309.57 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $2,570.40
| Facility | | $575.44 | $794.33 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,071.52
| Professional | | $870.96 | $870.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $660.69 / $1,174.90
| Facility | | $457.09 | $660.69 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |