- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,754.40 / $8,128.31
| Facility | | $3,388.44 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,079.46 / $11,220.18
| Facility | | $6,025.60 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,918.31 / $13,489.63
| Facility | | $2,290.87 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,467.37 / $7,943.28
| Facility | | $2,089.30 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,623.41 / $7,585.78
| Professional | | $2,884.03 | $5,623.41 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $16,218.10 / $16,218.10
| Facility | | $5,888.44 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,786.30 / $19,498.45
| Facility | | $2,290.87 | $4,786.30 | $19,498.45 |