- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $9,549.93
| Facility | | $3,019.95 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $19,054.61 / $26,302.68
| Facility | | $8,709.64 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,691.53 / $6,760.83
| Professional | | $2,137.96 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,884.03 / $6,025.60
| Professional | | $2,290.87 | $2,884.03 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,388.44 / $5,248.07
| Facility | | $2,454.71 | $3,388.44 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,235.94 / $9,549.93
| Facility | | $1,949.84 | $3,235.94 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |