- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $8,709.64
| Facility | | $1,621.81 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,621.81 / $1,949.84
| Facility | | $891.25 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $2,187.76
| Professional | | $1,023.29 | $1,023.29 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $2,089.30
| Facility | | $758.58 | $1,096.48 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,471.29
| Facility | | $1,479.11 | $6,760.83 | $10,471.29 |