- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,630.78 / $9,549.93
| Facility | | $1,174.90 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $2,630.27
| Professional | | $831.76 | $1,047.13 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $2,290.87
| Professional | | $870.96 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $1,995.26
| Facility | | $933.25 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $8,709.64
| Facility | | $741.31 | $1,148.15 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,413.10 / $14,125.38
| Facility | | $3,890.45 | $7,413.10 | $14,125.38 |