- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.29 / $2,878.14 / $14,482.00
| Facility | | $1,173.29 | $2,878.14 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,496.00 / $5,962.00
| Facility | | $1,905.00 | $3,496.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.28 / $2,425.13 / $3,911.65
| Facility | | $2,075.28 | $2,425.13 | $3,911.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.74 / $1,072.79 / $1,598.48
| Facility | | $717.74 | $1,072.79 | $1,598.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.88 / $2,783.00 / $6,150.00
| Facility | | $801.88 | $2,783.00 | $6,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.74 / $1,072.79 / $2,008.00
| Facility | | $717.74 | $1,072.79 | $2,008.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,395.00 / $1,841.40 / $2,613.77
| Professional | | $1,395.00 | $1,841.40 | $2,613.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,887.55 / $6,887.55 / $6,887.55
| Facility | | $6,887.55 | $6,887.55 | $6,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $4,523.30 / $6,072.00
| Facility | | $2,960.00 | $4,523.30 | $6,072.00 |