- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,890.45 / $9,549.93
| Facility | | $2,630.27 | $3,890.45 | $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
- $1,995.26 / $2,398.83 / $3,890.45
| Professional | | $1,995.26 | $2,398.83 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,187.76 / $3,548.13
| Professional | | $2,089.30 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,754.23 / $4,365.16
| Facility | | $1,995.26 | $2,754.23 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,570.40 / $5,248.07
| Facility | | $1,778.28 | $2,570.40 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,019.95 / $6,309.57
| Facility | | $407.38 | $3,019.95 | $6,309.57 |