- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.57 / $5,595.00 / $10,572.00
| Facility | | $1,285.57 | $5,595.00 | $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
- $1,216.55 / $1,462.58 / $1,989.54
| Facility | | $1,216.55 | $1,462.58 | $1,989.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.28 / $5,845.00 / $10,047.00
| Facility | | $811.28 | $5,845.00 | $10,047.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.76 / $1,135.72 / $1,945.50
| Professional | | $763.76 | $1,135.72 | $1,945.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.00 / $9,172.00 / $18,613.00
| Facility | | $1,998.00 | $9,172.00 | $18,613.00 |