- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,786.30 / $10,715.19
| Facility | | $3,235.94 | $4,786.30 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $19,054.61 / $26,302.68
| Facility | | $8,511.38 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $524.81 / $616.60
| Facility | | $489.78 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,467.37 / $5,754.40
| Professional | | $2,884.03 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,388.44 / $5,248.07
| Professional | | $3,235.94 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,801.89 / $6,025.60
| Facility | | $2,818.38 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $6,918.31
| Facility | | $2,454.71 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,019.95 / $6,309.57
| Facility | | $407.38 | $3,019.95 | $6,309.57 |