- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,606.93 / $16,982.44
| Facility | | $2,511.89 | $6,606.93 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,317.64 / $15,848.93
| Facility | | $4,677.35 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,548.13 / $9,549.93
| Facility | | $66.07 | $3,548.13 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,202.26 / $1,621.81
| Professional | | $588.84 | $1,202.26 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $2,754.23
| Professional | | $977.24 | $1,288.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $48,977.88
| Facility | | $28,840.32 | $28,840.32 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $2,238.72
| Facility | | $1,023.29 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,000.00 / $21,379.62
| Facility | | $5,370.32 | $10,000.00 | $21,379.62 |