- 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
- $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
- $1,380.38 / $1,737.80 / $4,365.16
| Professional | | $1,380.38 | $1,737.80 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,630.27 / $3,630.78
| Professional | | $2,089.30 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $3,311.31
| Facility | | $1,548.82 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,089.30 / $6,918.31
| Facility | | $1,412.54 | $2,089.30 | $6,918.31 |
- 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 |