- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.46 / $1,371.97 / $14,482.00
| Facility | | $724.46 | $1,371.97 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,780.00 / $7,344.00
| Facility | | $2,740.00 | $4,780.00 | $7,344.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.11 / $2,831.60 / $4,567.27
| Facility | | $2,423.11 | $2,831.60 | $4,567.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.73 / $953.19 / $1,646.36
| Facility | | $470.73 | $953.19 | $1,646.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.11 / $1,290.10 / $8,384.00
| Facility | | $531.11 | $1,290.10 | $8,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.73 / $887.88 / $1,704.64
| Facility | | $470.73 | $887.88 | $1,704.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.41 / $1,703.00 / $2,952.92
| Professional | | $942.41 | $1,703.00 | $2,952.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,399.78 / $3,399.78 / $3,399.78
| Facility | | $3,399.78 | $3,399.78 | $3,399.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,614.00 / $6,477.00 / $8,384.00
| Facility | | $4,614.00 | $6,477.00 | $8,384.00 |