- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.36 / $5,175.00 / $10,572.00
| Facility | | $1,044.36 | $5,175.00 | $10,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.02 / $3,763.81 / $13,523.26
| Facility | | $1,082.02 | $3,763.81 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.14 / $1,238.11 / $1,684.20
| Facility | | $1,024.14 | $1,238.11 | $1,684.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.58 / $5,845.00 / $10,047.00
| Facility | | $669.58 | $5,845.00 | $10,047.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.54 / $921.83 / $1,747.63
| Professional | | $646.54 | $921.83 | $1,747.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.00 / $10,496.00 / $18,613.00
| Facility | | $1,998.00 | $10,496.00 | $18,613.00 |