- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.17 / $4,781.89 / $14,482.00
| Facility | | $2,359.17 | $4,781.89 | $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
- $5,981.63 / $6,990.01 / $11,274.64
| Facility | | $5,981.63 | $6,990.01 | $11,274.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.17 / $3,234.04 / $9,903.65
| Facility | | $2,359.17 | $3,234.04 | $9,903.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.82 / $3,583.00 / $9,903.65
| Facility | | $2,337.82 | $3,583.00 | $9,903.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,359.17 / $3,234.04 / $9,903.65
| Facility | | $2,359.17 | $3,234.04 | $9,903.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,572.75 / $7,061.03 / $9,520.58
| Professional | | $4,572.75 | $7,061.03 | $9,520.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,507.27 / $24,507.27 / $24,507.27
| Facility | | $24,507.27 | $24,507.27 | $24,507.27 |
- 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 |