- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,570.40 / $14,454.40
| Facility | | $1,445.44 | $2,570.40 | $14,454.40 |
- 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
- $3,235.94 / $3,801.89 / $6,025.60
| Facility | | $3,235.94 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,918.31 / $13,489.63
| Facility | | $1,445.44 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $7,943.28
| Facility | | $1,445.44 | $2,691.53 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $4,265.80
| Professional | | $1,584.89 | $3,090.30 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $12,022.64 / $12,022.64
| Facility | | $3,235.94 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,786.30 / $19,498.45
| Facility | | $1,778.28 | $4,786.30 | $19,498.45 |