- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $10,232.93 / $20,417.38
| Facility | | $1,862.09 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $12,302.69
| Facility | | $2,754.23 | $6,456.54 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,344.23 / $2,570.40
| Facility | | $1,148.15 | $2,344.23 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,513.56
| Professional | | $1,047.13 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $891.25 / $1,479.11
| Facility | | $645.65 | $891.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |