- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.22 / $4,771.00 / $14,187.00
| Facility | | $1,093.22 | $4,771.00 | $14,187.00 |
- 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
- $912.02 / $1,094.42 / $1,349.79
| Professional | | $912.02 | $1,094.42 | $1,349.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.83 / $1,340.11 / $1,873.13
| Facility | | $1,036.83 | $1,340.11 | $1,873.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.33 / $1,283.35 / $2,307.69
| Facility | | $947.33 | $1,283.35 | $2,307.69 |
- 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 |