- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,096.19 / $7,649.34 / $18,054.00
| Facility | | $2,096.19 | $7,649.34 | $18,054.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,531.00 / $17,046.58 / $23,861.81
| Facility | | $10,531.00 | $17,046.58 | $23,861.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $2,104.98
| Facility | | $490.00 | $610.00 | $2,104.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.79 / $2,108.39 / $3,023.72
| Professional | | $1,706.79 | $2,108.39 | $3,023.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.63 / $2,425.67 / $3,535.55
| Facility | | $1,905.63 | $2,425.67 | $3,535.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,814.96 / $2,289.30 / $4,291.57
| Facility | | $1,814.96 | $2,289.30 | $4,291.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.00 / $12,407.00 / $26,244.00
| Facility | | $2,020.00 | $12,407.00 | $26,244.00 |