- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,311.31 / $16,595.87
| Facility | | $1,412.54 | $3,311.31 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,054.61 / $26,302.68
| Facility | | $11,748.98 | $19,054.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $3,548.13
| Professional | | $1,148.15 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $3,090.30
| Professional | | $1,778.28 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $2,818.38
| Facility | | $1,318.26 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,778.28 / $5,888.44
| Facility | | $1,258.93 | $1,778.28 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |