- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $13,489.63 / $23,442.29
| Facility | | $5,370.32 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $20,892.96
| Facility | | $9,120.11 | $12,882.50 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $7,079.46 / $13,489.63
| Facility | | $870.96 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $8,709.64 / $16,595.87
| Facility | | $851.14 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,737.80 / $2,398.83
| Professional | | $912.01 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,218.10 / $16,218.10
| Facility | | $10,964.78 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,378.01
| Facility | | $8,912.51 | $13,803.84 | $17,378.01 |