- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,786.30 / $14,454.40
| Facility | | $2,570.40 | $4,786.30 | $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
- $6,025.60 / $7,079.46 / $11,220.18
| Facility | | $6,025.60 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $8,128.31
| Facility | | $2,137.96 | $3,019.95 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,884.03 / $6,165.95
| Facility | | $2,137.96 | $2,884.03 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,370.32 / $8,317.64
| Professional | | $2,951.21 | $5,370.32 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $22,387.21 / $22,387.21
| Facility | | $6,025.60 | $22,387.21 | $22,387.21 |
- 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 |