- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $14,809.00 / $31,764.56
| Facility | | $4,500.00 | $14,809.00 | $31,764.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34,906.24 / $34,906.24 / $34,906.24
| Professional | | $34,906.24 | $34,906.24 | $34,906.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,582.47 / $49,692.55 / $96,135.53
| Facility | | $32,582.47 | $49,692.55 | $96,135.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,197.35 / $30,197.35 / $30,197.35
| Facility | | $30,197.35 | $30,197.35 | $30,197.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,402.31 / $37,681.94 / $90,662.59
| Facility | | $16,402.31 | $37,681.94 | $90,662.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,707.31 / $42,437.00 / $79,999.20
| Facility | | $16,707.31 | $42,437.00 | $79,999.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,582.47 / $48,589.87 / $95,056.24
| Facility | | $32,582.47 | $48,589.87 | $95,056.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $13,441.00 / $26,100.00
| Facility | | $3,340.00 | $13,441.00 | $26,100.00 |