- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.92 / $4,796.00 / $10,767.00
| Facility | | $1,269.92 | $4,796.00 | $10,767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,362.13 / $8,012.60 / $11,216.04
| Facility | | $5,362.13 | $8,012.60 | $11,216.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,261.02
| Facility | | $490.00 | $610.00 | $1,261.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.56 / $1,261.93 / $1,827.06
| Professional | | $1,021.56 | $1,261.93 | $1,827.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.61 / $1,430.15 / $2,146.16
| Facility | | $1,121.61 | $1,430.15 | $2,146.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.35 / $1,377.60 / $2,591.85
| Facility | | $1,101.35 | $1,377.60 | $2,591.85 |
- 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 |