- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.73 / $5,048.00 / $9,539.00
| Facility | | $2,153.73 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,480.37 / $9,394.00 / $12,872.86
| Facility | | $6,480.37 | $9,394.00 | $12,872.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.81 / $2,085.37 / $2,571.96
| Professional | | $1,737.81 | $2,085.37 | $2,571.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,992.34 / $2,624.67 / $3,791.84
| Facility | | $1,992.34 | $2,624.67 | $3,791.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.00 / $2,501.17 / $4,558.82
| Facility | | $1,736.00 | $2,501.17 | $4,558.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |