- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.71 / $5,282.00 / $13,088.72
| Facility | | $1,604.71 | $5,282.00 | $13,088.72 |
- 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
- $1,327.61 / $1,593.13 / $1,967.88
| Professional | | $1,327.61 | $1,593.13 | $1,967.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,477.53 / $1,871.03 / $2,686.20
| Facility | | $1,477.53 | $1,871.03 | $2,686.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.48 / $1,831.92 / $3,497.55
| Facility | | $1,334.48 | $1,831.92 | $3,497.55 |
- 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 |