- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,079.46 / $16,982.44
| Facility | | $2,187.76 | $7,079.46 | $16,982.44 |
- 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
- $1,122.02 / $1,412.54 / $3,548.13
| Professional | | $1,122.02 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $3,090.30
| Professional | | $1,698.24 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,819.70 / $2,691.53
| Facility | | $1,288.25 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,737.80 / $10,000.00
| Facility | | $1,202.26 | $1,737.80 | $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 |