- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $12,022.64 / $18,197.01
| Facility | | $5,128.61 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,378.01
| Facility | | $3,630.78 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,090.30 / $3,801.89
| Facility | | $562.34 | $3,090.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $2,089.30
| Professional | | $1,584.89 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,344.23 / $3,801.89
| Facility | | $1,584.89 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $16,982.44 / $25,703.96
| Facility | | $1,698.24 | $16,982.44 | $25,703.96 |