- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.42 / $4,771.00 / $8,920.00
| Facility | | $1,490.42 | $4,771.00 | $8,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,807.00 / $17,284.09 / $24,194.30
| Facility | | $7,807.00 | $17,284.09 | $24,194.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,461.82
| Facility | | $490.00 | $610.00 | $1,461.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.43 / $1,512.55 / $2,219.27
| Professional | | $1,239.43 | $1,512.55 | $2,219.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.33 / $1,667.44 / $2,454.03
| Facility | | $1,203.33 | $1,667.44 | $2,454.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.00 / $1,611.70 / $2,934.65
| Facility | | $1,227.00 | $1,611.70 | $2,934.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |