- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,734.01 / $4,771.00 / $10,767.00
| Facility | | $1,734.01 | $4,771.00 | $10,767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,738.20 / $20,977.18 / $29,216.95
| Facility | | $12,738.20 | $20,977.18 | $29,216.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $1,700.00 / $1,766.56
| Facility | | $1,700.00 | $1,700.00 | $1,766.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.11 / $1,903.79 / $2,249.94
| Professional | | $1,471.11 | $1,903.79 | $2,249.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.82 / $1,995.83 / $2,974.92
| Facility | | $1,556.82 | $1,995.83 | $2,974.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,455.08 / $1,931.44 / $6,487.11
| Facility | | $1,455.08 | $1,931.44 | $6,487.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.00 / $20,974.00 / $40,876.00
| Facility | | $7,621.00 | $20,974.00 | $40,876.00 |