- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,630.78 / $9,549.93
| Facility | | $2,187.76 | $3,630.78 | $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
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,454.71 / $2,951.21
| Professional | | $1,905.46 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,467.37 / $4,897.79
| Professional | | $2,754.23 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,754.23 / $4,168.69
| Facility | | $1,995.26 | $2,754.23 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $5,248.07
| Facility | | $1,819.70 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,388.44 / $7,079.46
| Facility | | $1,584.89 | $3,388.44 | $7,079.46 |