- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $13,182.57 / $41,686.94
| Facility | | $3,019.95 | $13,182.57 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $9,120.11 / $21,379.62
| Facility | | $3,090.30 | $9,120.11 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,905.46
| Facility | | $34.67 | $575.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,737.80
| Professional | | $1,479.11 | $1,479.11 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,513.56 / $2,398.83
| Facility | | $1,122.02 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $16,982.44 / $25,703.96
| Facility | | $2,089.30 | $16,982.44 | $25,703.96 |