- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $10,964.78 / $18,197.01
| Facility | | $3,019.95 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,332.54 / $17,378.01
| Facility | | $3,981.07 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,737.80 / $4,786.30
| Facility | | $812.83 | $1,737.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $2,511.89
| Professional | | $1,737.80 | $1,737.80 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,454.71
| Facility | | $1,071.52 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |