- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,630.78 / $9,549.93
| Facility | | $1,621.81 | $3,630.78 | $9,549.93 |
- 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
- $1,148.15 / $1,348.96 / $1,698.24
| Professional | | $1,148.15 | $1,348.96 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,511.89 / $3,019.95
| Professional | | $1,949.84 | $2,511.89 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $2,951.21
| Facility | | $1,288.25 | $1,949.84 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,819.70 / $7,413.10
| Facility | | $1,230.27 | $1,819.70 | $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 |