- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,244.36 / $16,595.87
| Facility | | $2,630.27 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,778.28 / $3,162.28
| Facility | | $812.83 | $1,778.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,659.59 / $6,025.60
| Facility | | $575.44 | $1,659.59 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,290.87
| Professional | | $1,513.56 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $2,137.96
| Facility | | $977.24 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $17,378.01
| Facility | | $1,995.26 | $11,220.18 | $17,378.01 |