- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.26 / $5,360.00 / $9,347.59
| Facility | | $1,050.26 | $5,360.00 | $9,347.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.06 / $705.06 / $776.00
| Facility | | $705.06 | $705.06 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.60 / $755.97 / $884.77
| Professional | | $590.60 | $755.97 | $884.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.77 / $832.11 / $1,255.00
| Facility | | $634.77 | $832.11 | $1,255.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.04 / $813.44 / $2,637.46
| Facility | | $612.04 | $813.44 | $2,637.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |