- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,630.78 / $9,549.93
| Facility | | $2,187.76 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $2,290.87
| Professional | | $1,548.82 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,786.30 / $5,888.44
| Professional | | $4,073.80 | $4,786.30 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,019.95 / $5,623.41
| Facility | | $1,778.28 | $3,019.95 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,691.53 / $10,000.00
| Facility | | $1,737.80 | $2,691.53 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |