- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,751.19 / $6,042.04 / $14,482.00
| Facility | | $2,751.19 | $6,042.04 | $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
- $7,677.54 / $8,971.82 / $14,471.22
| Facility | | $7,677.54 | $8,971.82 | $14,471.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,751.19 / $3,879.41 / $5,880.00
| Facility | | $2,751.19 | $3,879.41 | $5,880.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,627.37 / $4,065.92 / $7,700.00
| Facility | | $2,627.37 | $4,065.92 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,751.19 / $3,879.41 / $5,880.00
| Facility | | $2,751.19 | $3,879.41 | $5,880.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,879.25 / $9,078.46 / $12,911.30
| Professional | | $5,879.25 | $9,078.46 | $12,911.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,198.36 / $42,198.36 / $42,198.36
| Facility | | $42,198.36 | $42,198.36 | $42,198.36 |
- 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 |