- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.88 / $5,048.00 / $14,796.00
| Facility | | $1,277.88 | $5,048.00 | $14,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,604.05 / $10,127.70 / $14,105.84
| Facility | | $6,604.05 | $10,127.70 | $14,105.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.81 / $1,278.97 / $1,577.40
| Professional | | $1,065.81 | $1,278.97 | $1,577.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.72 / $1,568.31 / $2,213.06
| Facility | | $1,214.72 | $1,568.31 | $2,213.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.06 / $1,504.47 / $2,717.12
| Facility | | $1,113.06 | $1,504.47 | $2,717.12 |
- 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 |