- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.79 / $5,048.00 / $9,347.59
| Facility | | $1,676.79 | $5,048.00 | $9,347.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.00 / $776.00 / $1,703.12
| Facility | | $776.00 | $776.00 | $1,703.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,702.90 / $2,203.75 / $2,604.42
| Professional | | $1,702.90 | $2,203.75 | $2,604.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.22 / $1,862.36 / $3,200.43
| Facility | | $1,068.22 | $1,862.36 | $3,200.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.86 / $1,281.72 / $4,368.57
| Facility | | $840.86 | $1,281.72 | $4,368.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,475.00 / $21,639.00
| Facility | | $6,423.00 | $11,475.00 | $21,639.00 |