- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,019.95 / $14,454.40
| Facility | | $1,862.09 | $3,019.95 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,365.16 / $7,079.46
| Facility | | $3,801.89 | $4,365.16 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,244.36 / $13,489.63
| Facility | | $1,737.80 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,311.31 / $9,549.93
| Facility | | $1,698.24 | $3,311.31 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $6,309.57
| Professional | | $2,691.53 | $3,801.89 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $28,183.83 / $28,183.83
| Facility | | $3,801.89 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |