- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $14,454.40
| Facility | | $1,513.56 | $2,818.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,803.84
| Facility | | $5,011.87 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,168.69 / $6,606.93
| Facility | | $3,548.13 | $4,168.69 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $8,128.31
| Facility | | $1,288.25 | $1,778.28 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,778.28 / $5,888.44
| Facility | | $1,318.26 | $1,778.28 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $4,786.30
| Professional | | $1,737.80 | $3,090.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $12,882.50 / $12,882.50
| Facility | | $3,548.13 | $12,882.50 | $12,882.50 |
- 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 |