- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.73 / $5,412.00 / $11,024.00
| Facility | | $1,016.73 | $5,412.00 | $11,024.00 |
- 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
- $848.03 / $1,017.64 / $1,255.08
| Professional | | $848.03 | $1,017.64 | $1,255.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.61 / $1,247.81 / $1,749.64
| Facility | | $964.61 | $1,247.81 | $1,749.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.76 / $1,209.00 / $5,122.00
| Facility | | $926.76 | $1,209.00 | $5,122.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |