- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,344.23 / $14,454.40
| Facility | | $1,122.02 | $2,344.23 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,467.37 / $5,495.41
| Facility | | $2,951.21 | $3,467.37 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,344.23 / $5,754.40
| Facility | | $1,148.15 | $2,344.23 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,570.40 / $8,317.64
| Facility | | $1,174.90 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,570.40 / $3,981.07
| Professional | | $1,698.24 | $2,570.40 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $7,244.36
| Facility | | $2,454.71 | $4,570.88 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |