- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,786.30 / $10,715.19
| Facility | | $3,235.94 | $4,786.30 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $23,442.29 / $31,622.78
| Facility | | $13,803.84 | $23,442.29 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,548.13 / $9,120.11
| Professional | | $2,818.38 | $3,548.13 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,370.32 / $7,244.36
| Professional | | $4,168.69 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $6,606.93
| Facility | | $3,090.30 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,073.80 / $10,000.00
| Facility | | $2,290.87 | $4,073.80 | $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 |