- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,897.79 / $8,317.64
| Facility | | $1,174.90 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $891.25 / $1,148.15
| Professional | | $758.58 | $891.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $1,202.26
| Professional | | $933.25 | $1,047.13 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,047.13 / $1,621.81
| Facility | | $758.58 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,071.52 / $8,709.64
| Facility | | $630.96 | $1,071.52 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |