- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,630.27 / $13,182.57
| Facility | | $2,041.74 | $2,630.27 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,862.09 / $2,137.96
| Professional | | $933.25 | $1,862.09 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,187.76 / $17,378.01
| Facility | | $1,202.26 | $2,187.76 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,949.84 / $2,041.74
| Facility | | $1,659.59 | $1,949.84 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $2,454.71
| Facility | | $1,000.00 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $16,595.87
| Facility | | $10,715.19 | $13,803.84 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $16,218.10 / $23,988.33
| Facility | | $2,884.03 | $16,218.10 | $23,988.33 |