- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,079.46 / $16,595.87
| Facility | | $1,318.26 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $3,162.28
| Professional | | $1,023.29 | $1,258.93 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $2,691.53
| Professional | | $1,513.56 | $1,905.46 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $2,398.83
| Facility | | $1,148.15 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $15,135.61
| Facility | | $1,071.52 | $1,584.89 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $18,620.87 / $40,738.03
| Facility | | $10,964.78 | $18,620.87 | $40,738.03 |