- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,265.80 / $9,549.93
| Facility | | $2,630.27 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $22,387.21 / $38,018.94
| Facility | | $12,882.50 | $22,387.21 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $6,918.31
| Professional | | $2,187.76 | $2,754.23 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $5,623.41
| Professional | | $2,630.27 | $3,311.31 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,311.31 / $5,011.87
| Facility | | $2,454.71 | $3,311.31 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $9,120.11
| Facility | | $1,949.84 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |