- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,888.44 / $16,982.44
| Facility | | $1,230.27 | $5,888.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $11,481.54
| Facility | | $7,244.36 | $11,220.18 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $2,089.30
| Facility | | $489.78 | $616.60 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,737.80
| Professional | | $851.14 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,318.26 / $1,621.81
| Professional | | $1,230.27 | $1,318.26 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $1,905.46
| Facility | | $954.99 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $4,168.69
| Facility | | $912.01 | $1,148.15 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $14,125.38 / $35,481.34
| Facility | | $4,570.88 | $14,125.38 | $35,481.34 |