- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,235.94 / $8,128.31
| Facility | | $1,174.90 | $3,235.94 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $2,187.76
| Facility | | $1,698.24 | $1,995.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,445.44 / $2,754.23
| Facility | | $489.78 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $1,659.59
| Facility | | $794.33 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $14,125.38
| Facility | | $1,148.15 | $5,128.61 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $28,840.32
| Facility | | $9,549.93 | $9,549.93 | $28,840.32 |