- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.48 / $5,632.52 / $14,482.00
| Facility | | $2,546.48 | $5,632.52 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,499.00 / $16,401.00 / $25,162.36
| Facility | | $11,499.00 | $16,401.00 | $25,162.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,108.94 / $8,307.35 / $13,399.47
| Facility | | $7,108.94 | $8,307.35 | $13,399.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.48 / $3,204.28 / $5,382.18
| Facility | | $2,546.48 | $3,204.28 | $5,382.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.48 / $3,699.57 / $7,700.00
| Facility | | $2,546.48 | $3,699.57 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.48 / $3,204.28 / $5,382.18
| Facility | | $2,546.48 | $3,204.28 | $5,382.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,784.35 / $8,899.00 / $11,716.12
| Professional | | $5,784.35 | $8,899.00 | $11,716.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,419.83 / $40,419.83 / $40,419.83
| Facility | | $40,419.83 | $40,419.83 | $40,419.83 |
- 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 |