- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $9,549.93
| Facility | | $1,412.54 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,054.61 / $26,302.68
| Facility | | $11,748.98 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $3,715.35
| Professional | | $1,174.90 | $1,445.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $2,884.03
| Professional | | $1,513.56 | $1,905.46 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,698.24 / $2,630.27
| Facility | | $1,288.25 | $1,698.24 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $5,370.32
| Facility | | $1,096.48 | $1,659.59 | $5,370.32 |
- 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 |