- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,786.30 / $15,135.61
| Facility | | $1,288.25 | $4,786.30 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $11,220.18 / $15,488.17
| Facility | | $6,918.31 | $11,220.18 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $3,388.44
| Professional | | $1,071.52 | $1,348.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,905.46 / $2,754.23
| Professional | | $1,548.82 | $1,905.46 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $2,511.89
| Facility | | $1,230.27 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $5,248.07
| Facility | | $1,096.48 | $1,584.89 | $5,248.07 |
- 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 |