- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $14,125.38 / $20,417.38
| Facility | | $3,019.95 | $14,125.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $3,981.07
| Facility | | $2,137.96 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,265.80 / $7,762.47
| Facility | | $831.76 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $8,511.38 / $15,848.93
| Facility | | $912.01 | $8,511.38 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $2,818.38
| Professional | | $851.14 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $14,454.40
| Facility | | $9,772.37 | $9,772.37 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $16,218.10
| Facility | | $7,585.78 | $12,302.69 | $16,218.10 |