- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,365.16 / $9,549.93
| Facility | | $2,570.40 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $23,442.29 / $31,622.78
| Facility | | $13,803.84 | $23,442.29 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,691.53 / $6,760.83
| Professional | | $2,137.96 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $5,888.44
| Professional | | $2,951.21 | $3,715.35 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,388.44 / $5,011.87
| Facility | | $2,454.71 | $3,388.44 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,235.94 / $9,120.11
| Facility | | $2,137.96 | $3,235.94 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |