- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $10,000.00 / $15,848.93
| Facility | | $4,677.35 | $10,000.00 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $478.63
| Professional | | $173.78 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $1,819.70
| Professional | | $1,122.02 | $1,479.11 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $19,054.61 / $26,915.35
| Facility | | $14,454.40 | $19,054.61 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,471.29 / $16,218.10
| Facility | | $6,456.54 | $10,471.29 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $416.87 / $851.14
| Professional | | $288.40 | $416.87 | $851.14 |