- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $9,120.11 / $16,595.87
| Facility | | $1,819.70 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $18,620.87 / $34,673.69
| Facility | | $7,079.46 | $18,620.87 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $7,585.78
| Facility | | $575.44 | $891.25 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,513.56
| Professional | | $1,288.25 | $1,288.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $1,737.80
| Facility | | $660.69 | $1,000.00 | $1,737.80 |
- 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 |