- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.78 / $5,980.00 / $14,867.45
| Facility | | $1,550.78 | $5,980.00 | $14,867.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,076.18 / $14,552.64 / $20,189.45
| Facility | | $10,076.18 | $14,552.64 | $20,189.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.25 / $1,537.50 / $1,896.25
| Professional | | $1,281.25 | $1,537.50 | $1,896.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.32 / $1,775.48 / $2,533.41
| Facility | | $1,264.32 | $1,775.48 | $2,533.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.47 / $1,734.52 / $3,259.01
| Facility | | $1,305.47 | $1,734.52 | $3,259.01 |
- 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 |