- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,363.43 / $5,091.00 / $7,120.36
| Facility | | $3,363.43 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,285.00 / $1,285.00
| Facility | | $1,285.00 | $1,285.00 | $1,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.08 / $787.16 / $2,307.17
| Professional | | $436.08 | $787.16 | $2,307.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.72 / $1,182.72 / $7,379.00
| Facility | | $674.72 | $1,182.72 | $7,379.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.65 / $1,415.54 / $5,269.25
| Facility | | $1,011.65 | $1,415.54 | $5,269.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $7,487.00 / $11,732.00
| Facility | | $1,770.00 | $7,487.00 | $11,732.00 |