- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,051.05 / $4,390.00 / $8,920.00
| Facility | | $2,051.05 | $4,390.00 | $8,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,738.20 / $20,977.18 / $29,216.95
| Facility | | $12,738.20 | $20,977.18 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,757.12 / $2,108.54 / $2,602.71
| Professional | | $1,757.12 | $2,108.54 | $2,602.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,955.48 / $2,495.06 / $3,565.92
| Facility | | $1,955.48 | $2,495.06 | $3,565.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.27 / $2,393.52 / $4,437.07
| Facility | | $1,787.27 | $2,393.52 | $4,437.07 |
- 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 |