- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.92 / $5,048.00 / $9,539.00
| Facility | | $2,485.92 | $5,048.00 | $9,539.00 |
- 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 / $2,450.09
| Facility | | $490.00 | $610.00 | $2,450.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.89 / $2,511.30 / $3,692.02
| Professional | | $2,069.89 | $2,511.30 | $3,692.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,113.04 / $2,797.86 / $4,201.22
| Facility | | $2,113.04 | $2,797.86 | $4,201.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,069.89 / $2,678.04 / $4,748.04
| Facility | | $2,069.89 | $2,678.04 | $4,748.04 |
- 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 |