- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,120.11 / $16,595.87
| Facility | | $1,995.26 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,232.93 / $19,498.45
| Facility | | $2,951.21 | $10,232.93 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $616.60 / $3,630.78
| Facility | | $371.54 | $616.60 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $4,897.79
| Professional | | $1,258.93 | $1,258.93 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,584.89 / $7,413.10
| Facility | | $794.33 | $1,584.89 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $19,498.45 / $25,703.96
| Facility | | $2,089.30 | $19,498.45 | $25,703.96 |