- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,235.94 / $8,912.51
| Facility | | $1,023.29 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,951.21
| Facility | | $2,137.96 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $1,318.26
| Professional | | $870.96 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $2,238.72
| Professional | | $1,288.25 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $1,949.84
| Facility | | $891.25 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,174.90 / $2,398.83
| Facility | | $870.96 | $1,174.90 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $2,454.71
| Facility | | $218.78 | $1,202.26 | $2,454.71 |