- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,011.87 / $14,791.08
| Facility | | $1,659.59 | $5,011.87 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- 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
- $1,047.13 / $1,318.26 / $1,584.89
| Professional | | $1,047.13 | $1,318.26 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $2,754.23
| Professional | | $1,548.82 | $1,949.84 | $2,754.23 |
- 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
- $1,071.52 / $1,513.56 / $10,000.00
| Facility | | $1,071.52 | $1,513.56 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,220.18 / $23,988.33
| Facility | | $6,456.54 | $11,220.18 | $23,988.33 |