- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,041.74 / $14,454.40
| Facility | | $1,122.02 | $2,041.74 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,197.01
| Facility | | $6,606.93 | $10,964.78 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,090.30 / $4,897.79
| Facility | | $2,630.27 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $5,623.41
| Facility | | $851.14 | $1,230.27 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,288.25 / $7,943.28
| Facility | | $851.14 | $1,288.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,137.96 / $3,311.31
| Professional | | $1,174.90 | $2,137.96 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,595.87 / $16,595.87
| Facility | | $11,220.18 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,413.10 / $9,120.11
| Facility | | $5,128.61 | $7,413.10 | $9,120.11 |