- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,910.75 / $5,048.00 / $9,539.00
| Facility | | $2,910.75 | $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 / $2,917.75
| Facility | | $490.00 | $610.00 | $2,917.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.54 / $2,881.37 / $4,195.38
| Professional | | $2,332.54 | $2,881.37 | $4,195.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,972.00 / $3,043.06 / $4,755.10
| Facility | | $1,972.00 | $3,043.06 | $4,755.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,754.46 / $2,967.21 / $5,503.97
| Facility | | $1,754.46 | $2,967.21 | $5,503.97 |
- 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 |