- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,431.80 / $5,241.35 / $10,086.79
| Facility | | $3,431.80 | $5,241.35 | $10,086.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,385.00 / $10,311.04 / $14,433.40
| Facility | | $6,385.00 | $10,311.04 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,419.36
| Facility | | $490.00 | $610.00 | $3,419.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.61 / $3,401.52 / $4,936.71
| Professional | | $2,753.61 | $3,401.52 | $4,936.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,917.03 / $3,843.62 / $5,614.68
| Facility | | $2,917.03 | $3,843.62 | $5,614.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,826.57 / $3,658.00 / $6,489.23
| Facility | | $2,826.57 | $3,658.00 | $6,489.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |