- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,715.35 / $9,549.93
| Facility | | $2,290.87 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,595.87 / $22,908.68
| Facility | | $8,709.64 | $16,595.87 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $5,754.40
| Professional | | $1,862.09 | $2,290.87 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,467.37 / $5,011.87
| Professional | | $2,754.23 | $3,467.37 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,090.30 / $4,677.35
| Facility | | $2,137.96 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,884.03 / $8,317.64
| Facility | | $1,949.84 | $2,884.03 | $8,317.64 |
- 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 |