- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,128.31 / $32,359.37
| Facility | | $1,737.80 | $8,128.31 | $32,359.37 |
- 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
- $1,071.52 / $1,318.26 / $3,311.31
| Professional | | $1,071.52 | $1,318.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,995.26 / $2,818.38
| Professional | | $1,584.89 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $2,511.89
| Facility | | $1,071.52 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,659.59 / $17,378.01
| Facility | | $1,122.02 | $1,659.59 | $17,378.01 |
- 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 |