- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.45 / $2,645.03 / $14,482.00
| Facility | | $1,305.45 | $2,645.03 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,538.00 / $10,705.54 / $18,141.00
| Facility | | $6,538.00 | $10,705.54 | $18,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.22 / $3,874.10 / $6,248.78
| Facility | | $3,315.22 | $3,874.10 | $6,248.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.45 / $1,786.53 / $4,484.97
| Facility | | $1,305.45 | $1,786.53 | $4,484.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.45 / $2,576.54 / $7,700.00
| Facility | | $1,305.45 | $2,576.54 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.45 / $1,786.53 / $4,484.97
| Facility | | $1,305.45 | $1,786.53 | $4,484.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.15 / $3,905.40 / $5,255.61
| Professional | | $2,529.15 | $3,905.40 | $5,255.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,067.04 / $12,067.04 / $12,067.04
| Facility | | $12,067.04 | $12,067.04 | $12,067.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $4,316.80 / $19,003.00
| Facility | | $2,203.00 | $4,316.80 | $19,003.00 |