- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,471.29 / $18,197.01
| Facility | | $2,818.38 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,570.88 / $8,912.51
| Facility | | $2,187.76 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,778.28
| Facility | | $34.67 | $575.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,584.89
| Professional | | $1,318.26 | $1,318.26 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,348.96 / $2,187.76
| Facility | | $1,023.29 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $22,908.68
| Facility | | $1,230.27 | $12,589.25 | $22,908.68 |