- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.00 / $8,741.28 / $19,090.61
| Facility | | $3,027.00 | $8,741.28 | $19,090.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,999.00 / $26,120.00 / $67,429.00
| Facility | | $15,999.00 | $26,120.00 | $67,429.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,964.00 / $6,413.00 / $21,620.92
| Facility | | $5,964.00 | $6,413.00 | $21,620.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.99 / $1,283.95 / $1,710.22
| Facility | | $1,017.99 | $1,283.95 | $1,710.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.48 / $1,412.35 / $3,477.31
| Professional | | $990.48 | $1,412.35 | $3,477.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,650.00 / $28,300.00 / $37,402.00
| Facility | | $14,650.00 | $28,300.00 | $37,402.00 |