- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,659.59 / $14,454.40
| Facility | | $1,047.13 | $1,659.59 | $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
- $2,089.30 / $2,454.71 / $3,981.07
| Facility | | $2,089.30 | $2,454.71 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $7,244.36 / $13,489.63
| Facility | | $1,047.13 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $7,079.46 / $12,302.69
| Facility | | $954.99 | $7,079.46 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $3,467.37
| Professional | | $1,380.38 | $1,995.26 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,232.93 / $10,232.93
| Facility | | $6,760.83 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $13,182.57
| Facility | | $6,606.93 | $10,232.93 | $13,182.57 |