- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,370.32 / $10,964.78
| Facility | | $1,348.96 | $5,370.32 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $1,445.44
| Professional | | $977.24 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $2,290.87
| Facility | | $1,071.52 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,445.44 / $10,000.00
| Facility | | $1,047.13 | $1,445.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $23,988.33
| Facility | | $6,760.83 | $11,481.54 | $23,988.33 |