- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $7,413.10 / $19,498.45
| Facility | | $1,230.27 | $7,413.10 | $19,498.45 |
- 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
- $851.14 / $1,047.13 / $2,630.27
| Professional | | $851.14 | $1,047.13 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,290.87
| Professional | | $1,318.26 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,348.96 / $1,905.46
| Facility | | $870.96 | $1,348.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,318.26 / $10,964.78
| Facility | | $891.25 | $1,318.26 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,882.50 / $29,512.09
| Facility | | $8,317.64 | $12,882.50 | $29,512.09 |