- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.98 / $5,280.80 / $10,063.29
| Facility | | $3,437.98 | $5,280.80 | $10,063.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,738.20 / $20,977.18 / $29,216.95
| Facility | | $12,738.20 | $20,977.18 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,851.22 / $3,421.46 / $4,233.43
| Professional | | $2,851.22 | $3,421.46 | $4,233.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,326.57 / $4,000.61 / $5,810.19
| Facility | | $3,326.57 | $4,000.61 | $5,810.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.41 / $3,762.46 / $7,078.00
| Facility | | $2,500.41 | $3,762.46 | $7,078.00 |
- 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 |