- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,786.30 / $15,135.61
| Facility | | $1,584.89 | $4,786.30 | $15,135.61 |
- 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
- $1,122.02 / $1,348.96 / $1,659.59
| Professional | | $1,122.02 | $1,348.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $2,951.21
| Professional | | $1,548.82 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,737.80 / $2,884.03
| Facility | | $1,288.25 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $7,413.10
| Facility | | $1,096.48 | $1,737.80 | $7,413.10 |
- 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 |