- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,774.40 / $6,121.04 / $14,482.00
| Facility | | $2,774.40 | $6,121.04 | $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
- $7,741.52 / $9,046.58 / $14,591.81
| Facility | | $7,741.52 | $9,046.58 | $14,591.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,774.40 / $3,950.78 / $6,142.50
| Facility | | $2,774.40 | $3,950.78 | $6,142.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,687.21 / $4,080.83 / $7,700.00
| Facility | | $2,687.21 | $4,080.83 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,774.40 / $3,950.78 / $6,142.50
| Facility | | $2,774.40 | $3,950.78 | $6,142.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,027.45 / $9,273.00 / $12,942.21
| Professional | | $6,027.45 | $9,273.00 | $12,942.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,824.64 / $42,824.64 / $42,824.64
| Facility | | $42,824.64 | $42,824.64 | $42,824.64 |
- 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 |