- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,079.46 / $21,877.62
| Facility | | $2,041.74 | $7,079.46 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $18,620.87 / $25,703.96
| Facility | | $11,220.18 | $18,620.87 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $524.81 / $616.60
| Facility | | $489.78 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $3,090.30
| Professional | | $1,548.82 | $1,862.09 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,344.23 / $3,981.07
| Professional | | $2,187.76 | $2,344.23 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,290.87 / $3,548.13
| Facility | | $1,698.24 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,089.30 / $6,456.54
| Facility | | $1,659.59 | $2,089.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $11,748.98 / $26,302.68
| Facility | | $2,511.89 | $11,748.98 | $26,302.68 |