- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,466.84 / $14,791.08
| Facility | | $1,584.89 | $4,466.84 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $38,018.94 / $39,810.72
| Facility | | $31,622.78 | $38,018.94 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $2,187.76
| Professional | | $1,412.54 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,398.83 / $3,467.37
| Professional | | $1,949.84 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $3,090.30
| Facility | | $1,445.44 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $10,000.00
| Facility | | $1,318.26 | $1,905.46 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $26,302.68 / $41,686.94
| Facility | | $10,471.29 | $26,302.68 | $41,686.94 |