- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $9,772.37 / $20,417.38
| Facility | | $1,819.70 | $9,772.37 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $15,488.17 / $33,113.11
| Facility | | $4,265.80 | $15,488.17 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $7,943.28
| Facility | | $575.44 | $891.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,548.82
| Professional | | $1,479.11 | $1,479.11 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $1,659.59
| Facility | | $676.08 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |