- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,265.80 / $14,454.40
| Facility | | $2,290.87 | $4,265.80 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,489.63
| Facility | | $5,011.87 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,309.57 / $10,000.00
| Facility | | $5,370.32 | $6,309.57 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,691.53 / $8,912.51
| Facility | | $1,949.84 | $2,691.53 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,691.53 / $6,165.95
| Facility | | $1,949.84 | $2,691.53 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,570.88 / $7,079.46
| Professional | | $2,511.89 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $19,054.61
| Facility | | $5,370.32 | $5,370.32 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |