- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.37 / $5,301.00 / $14,796.00
| Facility | | $2,430.37 | $5,301.00 | $14,796.00 |
- 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 / $2,393.94
| Facility | | $490.00 | $610.00 | $2,393.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,931.80 / $2,386.35 / $3,512.64
| Professional | | $1,931.80 | $2,386.35 | $3,512.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,191.08 / $2,787.02 / $4,033.33
| Facility | | $2,191.08 | $2,787.02 | $4,033.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.88 / $2,657.25 / $4,595.64
| Facility | | $2,070.88 | $2,657.25 | $4,595.64 |
- 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 |