- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,079.46 / $25,703.96
| Facility | | $1,548.82 | $7,079.46 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $18,620.87 / $18,620.87
| Facility | | $16,595.87 | $18,620.87 | $18,620.87 |
- 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
- $794.33 / $954.99 / $1,174.90
| Professional | | $794.33 | $954.99 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $1,819.70
| Professional | | $1,174.90 | $1,479.11 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $2,041.74
| Facility | | $912.01 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $34,673.69
| Facility | | $912.01 | $1,318.26 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $22,387.21 / $64,565.42
| Facility | | $13,182.57 | $22,387.21 | $64,565.42 |