- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,918.31 / $16,595.87
| Facility | | $1,318.26 | $6,918.31 | $16,595.87 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $6,456.54
| Facility | | $489.78 | $616.60 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $1,778.28
| Professional | | $1,000.00 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,238.72
| Facility | | $1,096.48 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $4,786.30
| Facility | | $1,174.90 | $1,513.56 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $12,302.69 / $29,512.09
| Facility | | $2,511.89 | $12,302.69 | $29,512.09 |