- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $9,549.93
| Facility | | $1,949.84 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $23,442.29 / $31,622.78
| Facility | | $13,803.84 | $23,442.29 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $5,623.41
| Professional | | $1,737.80 | $2,137.96 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $4,365.16
| Professional | | $2,454.71 | $3,162.28 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,630.27 / $3,890.45
| Facility | | $1,862.09 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,454.71 / $7,413.10
| Facility | | $1,659.59 | $2,454.71 | $7,413.10 |
- 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 |