- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,623.41 / $9,772.37
| Facility | | $2,041.74 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $19,054.61
| Facility | | $4,073.80 | $10,000.00 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,258.93
| Facility | | $501.19 | $776.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,737.80
| Professional | | $1,288.25 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $1,659.59
| Facility | | $741.31 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |