- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $9,549.93
| Facility | | $1,819.70 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,220.18 / $15,848.93
| Facility | | $6,760.83 | $11,220.18 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $524.81 / $616.60
| Facility | | $489.78 | $524.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,737.80 / $2,818.38
| Professional | | $1,412.54 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,089.30 / $3,162.28
| Professional | | $1,949.84 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $3,162.28
| Facility | | $1,513.56 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $3,801.89
| Facility | | $1,513.56 | $1,862.09 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,019.95 / $7,079.46
| Facility | | $407.38 | $3,019.95 | $7,079.46 |