- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,085.42 / $6,104.15 / $14,867.45
| Facility | | $2,085.42 | $6,104.15 | $14,867.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,076.18 / $14,552.64 / $20,189.45
| Facility | | $10,076.18 | $14,552.64 | $20,189.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,726.47 / $2,071.76 / $2,555.17
| Professional | | $1,726.47 | $2,071.76 | $2,555.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.35 / $2,402.13 / $3,524.36
| Facility | | $1,712.35 | $2,402.13 | $3,524.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.44 / $2,308.15 / $4,337.54
| Facility | | $1,745.44 | $2,308.15 | $4,337.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |