- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,261.52 / $5,069.50 / $7,767.00
| Facility | | $2,261.52 | $5,069.50 | $7,767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.70 / $3,859.05 / $8,545.91
| Facility | | $1,380.70 | $3,859.05 | $8,545.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,011.71 / $2,144.46 / $3,293.28
| Facility | | $2,011.71 | $2,144.46 | $3,293.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,685.16 / $3,685.16 / $3,685.16
| Facility | | $3,685.16 | $3,685.16 | $3,685.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.83 / $1,369.98 / $3,056.15
| Professional | | $1,053.83 | $1,369.98 | $3,056.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,738.00 / $7,794.00 / $14,048.00
| Facility | | $1,738.00 | $7,794.00 | $14,048.00 |