- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,801.89 / $14,454.40
| Facility | | $2,041.74 | $3,801.89 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,803.84
| Facility | | $5,011.87 | $8,128.31 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,495.41 / $8,912.51
| Facility | | $4,786.30 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $8,709.64
| Facility | | $1,778.28 | $2,511.89 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,511.89 / $6,165.95
| Facility | | $1,819.70 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,168.69 / $6,456.54
| Professional | | $2,344.23 | $4,168.69 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $26,302.68 / $26,302.68
| Facility | | $4,786.30 | $26,302.68 | $26,302.68 |
- 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 |