- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,786.30 / $12,882.50
| Facility | | $1,737.80 | $4,786.30 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $13,182.57 / $15,488.17
| Facility | | $9,772.37 | $13,182.57 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,778.28 / $2,089.30
| Professional | | $1,380.38 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $3,548.13
| Professional | | $1,905.46 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,995.26 / $3,019.95
| Facility | | $1,445.44 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $11,481.54
| Facility | | $1,348.96 | $1,905.46 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,882.50 / $29,512.09
| Facility | | $7,413.10 | $12,882.50 | $29,512.09 |