- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,089.30 / $14,454.40
| Facility | | $1,318.26 | $2,089.30 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $13,803.84 / $21,877.62
| Facility | | $10,000.00 | $13,803.84 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,090.30 / $4,897.79
| Facility | | $2,630.27 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,244.36 / $13,489.63
| Facility | | $1,202.26 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,818.38 / $9,549.93
| Facility | | $1,202.26 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $4,466.84
| Professional | | $1,819.70 | $2,570.40 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $13,489.63 / $13,489.63
| Facility | | $2,630.27 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |