- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,630.78 / $9,549.93
| Facility | | $1,621.81 | $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
- $1,230.27 / $1,479.11 / $2,454.71
| Professional | | $1,230.27 | $1,479.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,137.96 / $3,235.94
| Professional | | $1,905.46 | $2,137.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,862.09 / $2,818.38
| Facility | | $1,348.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $3,388.44
| Facility | | $1,380.38 | $1,737.80 | $3,388.44 |
- 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 |