- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $6,165.95 / $17,378.01
| Facility | | $1,348.96 | $6,165.95 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $30,199.52 / $30,199.52
| Facility | | $26,915.35 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,318.26 / $1,548.82
| Professional | | $1,047.13 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,089.30 / $2,754.23
| Professional | | $1,659.59 | $2,089.30 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $2,454.71
| Facility | | $1,122.02 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $16,218.10
| Facility | | $1,096.48 | $1,548.82 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $26,915.35 / $41,686.94
| Facility | | $10,964.78 | $26,915.35 | $41,686.94 |