- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $10,471.29 / $18,197.01
| Facility | | $1,949.84 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,918.31 / $13,182.57
| Facility | | $2,951.21 | $6,918.31 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,230.27 / $2,754.23
| Facility | | $537.03 | $1,230.27 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,148.15
| Professional | | $977.24 | $977.24 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $954.99 / $1,548.82
| Facility | | $707.95 | $954.99 | $1,548.82 |
- 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 |