- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,162.84 / $9,972.00 / $42,921.00
| Facility | | $2,162.84 | $9,972.00 | $42,921.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,341.30 / $2,341.30 / $2,341.30
| Facility | | $2,341.30 | $2,341.30 | $2,341.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.14 / $2,193.05 / $2,690.14
| Professional | | $1,670.14 | $2,193.05 | $2,690.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.90 / $1,820.22 / $2,880.47
| Facility | | $1,146.90 | $1,820.22 | $2,880.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.27 / $2,034.54 / $2,133.28
| Facility | | $1,476.27 | $2,034.54 | $2,133.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.42 / $2,101.98 / $2,880.47
| Facility | | $1,145.42 | $2,101.98 | $2,880.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,713.19 / $32,532.53 / $38,534.69
| Facility | | $23,713.19 | $32,532.53 | $38,534.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $17,375.00 / $26,255.00
| Facility | | $2,800.00 | $17,375.00 | $26,255.00 |