- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.75 / $5,620.90 / $14,482.00
| Facility | | $2,550.75 | $5,620.90 | $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
- $7,093.62 / $8,289.45 / $13,370.59
| Facility | | $7,093.62 | $8,289.45 | $13,370.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.75 / $3,783.61 / $5,407.50
| Facility | | $2,550.75 | $3,783.61 | $5,407.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,533.78 / $4,008.20 / $7,700.00
| Facility | | $2,533.78 | $4,008.20 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.75 / $3,783.61 / $5,407.50
| Facility | | $2,550.75 | $3,783.61 | $5,407.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,719.35 / $8,799.00 / $12,048.86
| Professional | | $5,719.35 | $8,799.00 | $12,048.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,236.48 / $40,236.48 / $40,236.48
| Facility | | $40,236.48 | $40,236.48 | $40,236.48 |
- 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 |