- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,137.96 / $7,943.28
| Facility | | $1,318.26 | $2,137.96 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,884.03
| Facility | | $2,290.87 | $2,290.87 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $1,995.26
| Professional | | $1,202.26 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $2,089.30
| Facility | | $831.76 | $1,122.02 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,659.59 / $1,737.80
| Facility | | $1,412.54 | $1,659.59 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $2,041.74
| Facility | | $794.33 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $12,022.64 / $14,791.08
| Facility | | $8,709.64 | $12,022.64 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $12,882.50 / $25,118.86
| Facility | | $1,995.26 | $12,882.50 | $25,118.86 |