- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,365.16 / $14,791.08
| Facility | | $2,290.87 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,995.26 / $2,454.71
| Professional | | $1,659.59 | $1,995.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $4,265.80
| Professional | | $2,630.27 | $3,311.31 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,754.23 / $4,265.80
| Facility | | $1,905.46 | $2,754.23 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,454.71 / $8,912.51
| Facility | | $1,659.59 | $2,454.71 | $8,912.51 |
- 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 |