- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $15,848.93 / $21,877.62
| Facility | | $2,041.74 | $15,848.93 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,819.70 / $2,398.83
| Professional | | $1,380.38 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $19,054.61
| Facility | | $1,148.15 | $1,949.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,905.46 / $1,995.26
| Facility | | $1,584.89 | $1,905.46 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $2,344.23
| Facility | | $1,023.29 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $32,359.37 / $38,904.51
| Facility | | $23,442.29 | $32,359.37 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $45,708.82
| Facility | | $3,019.95 | $20,892.96 | $45,708.82 |