- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.66 / $5,376.00 / $10,572.00
| Facility | | $1,705.66 | $5,376.00 | $10,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.94 / $4,864.55 / $14,509.03
| Facility | | $875.94 | $4,864.55 | $14,509.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,741.31 / $2,086.13 / $2,837.75
| Facility | | $1,741.31 | $2,086.13 | $2,837.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.83 / $6,122.06 / $10,047.00
| Facility | | $1,141.83 | $6,122.06 | $10,047.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.40 / $1,636.21 / $4,421.72
| Professional | | $1,089.40 | $1,636.21 | $4,421.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.00 / $10,000.00 / $18,613.00
| Facility | | $1,998.00 | $10,000.00 | $18,613.00 |