- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.51 / $5,405.00 / $10,572.00
| Facility | | $1,006.51 | $5,405.00 | $10,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.02 / $3,851.84 / $13,523.26
| Facility | | $1,082.02 | $3,851.84 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.53 / $1,240.17 / $1,687.01
| Facility | | $1,024.53 | $1,240.17 | $1,687.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.06 / $5,845.00 / $10,047.00
| Facility | | $671.06 | $5,845.00 | $10,047.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.64 / $905.76 / $1,635.17
| Professional | | $647.64 | $905.76 | $1,635.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $6,206.00 / $8,554.00
| Facility | | $1,800.00 | $6,206.00 | $8,554.00 |