- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,235.94 / $8,912.51
| Facility | | $1,698.24 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,232.93 / $14,125.38
| Facility | | $6,760.83 | $10,232.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,445.44 / $1,778.28
| Professional | | $1,202.26 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,238.72 / $3,162.28
| Professional | | $1,819.70 | $2,238.72 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $3,090.30
| Facility | | $1,348.96 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $7,413.10
| Facility | | $1,230.27 | $1,862.09 | $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 |