- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,119.04 / $11,611.47
| Facility | | $5,091.00 | $7,119.04 | $11,611.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $1,932.00 / $1,932.00
| Facility | | $1,932.00 | $1,932.00 | $1,932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,687.75 / $2,535.46 / $5,944.47
| Professional | | $1,687.75 | $2,535.46 | $5,944.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,934.96 / $4,171.82 / $11,732.00
| Facility | | $1,934.96 | $4,171.82 | $11,732.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.00 / $4,555.35 / $5,660.47
| Facility | | $2,851.00 | $4,555.35 | $5,660.47 |
- 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 |