- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $14,454.40
| Facility | | $1,288.25 | $2,398.83 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $11,220.18 / $20,892.96
| Facility | | $6,918.31 | $11,220.18 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,548.13 / $5,754.40
| Facility | | $3,090.30 | $3,548.13 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,918.31 / $13,489.63
| Facility | | $1,288.25 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $10,715.19 / $19,952.62
| Facility | | $1,288.25 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,818.38 / $3,890.45
| Professional | | $1,445.44 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $10,964.78 / $10,964.78
| Facility | | $3,019.95 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $16,218.10 / $21,379.62
| Facility | | $8,317.64 | $16,218.10 | $21,379.62 |