- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,079.46 / $15,848.93
| Facility | | $1,548.82 | $7,079.46 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $9,549.93 / $9,772.37
| Facility | | $8,709.64 | $9,549.93 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $16,218.10 / $46,773.51
| Facility | | $8,511.38 | $16,218.10 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $1,698.24
| Professional | | $1,148.15 | $1,380.38 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,995.26 / $2,570.40
| Professional | | $1,621.81 | $1,995.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $2,818.38
| Facility | | $1,288.25 | $1,995.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $11,481.54
| Facility | | $1,258.93 | $1,819.70 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,589.25 / $29,512.09
| Facility | | $7,413.10 | $12,589.25 | $29,512.09 |