- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,675.53 / $4,299.05 / $14,482.00
| Facility | | $2,675.53 | $4,299.05 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,080.00 / $18,175.43 / $28,720.00
| Facility | | $12,080.00 | $18,175.43 | $28,720.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,362.57 / $6,266.58 / $10,107.77
| Facility | | $5,362.57 | $6,266.58 | $10,107.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,101.76 / $3,024.59 / $4,136.71
| Facility | | $2,101.76 | $3,024.59 | $4,136.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $3,365.10 / $7,868.00
| Facility | | $2,203.00 | $3,365.10 | $7,868.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,101.76 / $3,024.59 / $4,136.71
| Facility | | $2,101.76 | $3,024.59 | $4,136.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,338.10 / $6,698.69 / $8,754.89
| Professional | | $4,338.10 | $6,698.69 | $8,754.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,168.03 / $28,168.03 / $28,168.03
| Facility | | $28,168.03 | $28,168.03 | $28,168.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $4,316.80 / $19,003.00
| Facility | | $2,203.00 | $4,316.80 | $19,003.00 |