- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,709.64 / $19,054.61
| Facility | | $3,311.31 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,623.41 / $11,220.18
| Facility | | $2,630.27 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,174.90 / $2,570.40
| Facility | | $575.44 | $1,174.90 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 22 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,584.89
| Professional | | $1,122.02 | $1,122.02 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $1,737.80
| Facility | | $676.08 | $912.01 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $13,182.57 / $23,442.29
| Facility | | $2,511.89 | $13,182.57 | $23,442.29 |