- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,760.83 / $15,488.17
| Facility | | $1,584.89 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $1,548.82
| Professional | | $1,000.00 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,698.24 / $2,137.96
| Professional | | $1,513.56 | $1,698.24 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,513.56 / $2,398.83
| Facility | | $1,096.48 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $10,000.00
| Facility | | $1,023.29 | $1,584.89 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |