- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,551.18 / $5,503.00 / $10,651.00
| Facility | | $1,551.18 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,946.00 / $9,472.00 / $17,487.00
| Facility | | $5,946.00 | $9,472.00 | $17,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,305.53 / $5,305.53 / $16,712.72
| Facility | | $5,305.53 | $5,305.53 | $16,712.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.65 / $1,962.59 / $3,176.60
| Facility | | $1,156.65 | $1,962.59 | $3,176.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.51 / $2,237.33 / $3,501.90
| Professional | | $1,480.51 | $2,237.33 | $3,501.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,251.00 / $11,924.00 / $19,712.00
| Facility | | $9,251.00 | $11,924.00 | $19,712.00 |