- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,630.78 / $9,549.93
| Facility | | $1,778.28 | $3,630.78 | $9,549.93 |
- 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
- $1,348.96 / $1,698.24 / $4,265.80
| Professional | | $1,348.96 | $1,698.24 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,819.70 / $3,467.37
| Professional | | $1,230.27 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,995.26 / $3,162.28
| Facility | | $1,445.44 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,995.26 / $6,606.93
| Facility | | $1,096.48 | $1,995.26 | $6,606.93 |
- 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 |