- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $8,709.64 / $11,481.54
| Facility | | $467.74 | $8,709.64 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $14,125.38 / $23,988.33
| Facility | | $10,000.00 | $14,125.38 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $18,197.01 / $29,512.09
| Facility | | $15,488.17 | $18,197.01 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,311.31 / $8,128.31
| Facility | | $467.74 | $3,311.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $10,964.78 / $19,498.45
| Facility | | $426.58 | $10,964.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $6,025.60 / $18,620.87
| Professional | | $741.31 | $6,025.60 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $16,982.44
| Facility | | $11,220.18 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $21,379.62
| Facility | | $8,709.64 | $16,982.44 | $21,379.62 |