- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.84 / $5,412.00 / $15,165.00
| Facility | | $2,312.84 | $5,412.00 | $15,165.00 |
- 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 / $2,284.78
| Facility | | $490.00 | $610.00 | $2,284.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.16 / $2,286.73 / $3,363.07
| Professional | | $1,851.16 | $2,286.73 | $3,363.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.26 / $2,616.98 / $3,816.19
| Facility | | $2,015.26 | $2,616.98 | $3,816.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.70 / $2,539.46 / $4,462.00
| Facility | | $1,988.70 | $2,539.46 | $4,462.00 |
- 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 |