- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,630.78 / $8,912.51
| Facility | | $1,737.80 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $19,054.61 / $26,302.68
| Facility | | $12,022.64 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $4,168.69
| Professional | | $1,318.26 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $3,388.44
| Professional | | $1,862.09 | $2,398.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $3,090.30
| Facility | | $1,513.56 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $6,456.54
| Facility | | $1,318.26 | $1,905.46 | $6,456.54 |
- 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 |