- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $17,782.79 / $37,153.52
| Facility | | $1,995.26 | $17,782.79 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $29,512.09
| Facility | | $13,803.84 | $18,620.87 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $4,570.88
| Facility | | $2,344.23 | $3,090.30 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $1,819.70
| Facility | | $912.01 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $13,489.63 / $23,442.29
| Facility | | $1,000.00 | $13,489.63 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $3,388.44
| Professional | | $1,548.82 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $14,454.40 / $14,454.40
| Facility | | $2,089.30 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,498.45 / $25,118.86
| Facility | | $10,000.00 | $19,498.45 | $25,118.86 |