- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,760.83 / $15,488.17
| Facility | | $2,187.76 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,951.21 / $3,890.45
| Facility | | $616.60 | $2,951.21 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,905.46 / $3,235.94
| Professional | | $1,548.82 | $1,905.46 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,659.59 / $2,951.21
| Professional | | $1,584.89 | $1,659.59 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,344.23 / $3,630.78
| Facility | | $1,659.59 | $2,344.23 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $7,079.46
| Facility | | $1,548.82 | $2,238.72 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $10,471.29 / $23,988.33
| Facility | | $2,137.96 | $10,471.29 | $23,988.33 |