- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.21 / $2,645.17 / $14,482.00
| Facility | | $1,189.21 | $2,645.17 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,878.00 / $14,586.00 / $21,869.00
| Facility | | $10,878.00 | $14,586.00 | $21,869.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,332.34 / $3,894.10 / $5,973.66
| Facility | | $3,332.34 | $3,894.10 | $5,973.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.21 / $1,783.82 / $3,070.92
| Facility | | $1,189.21 | $1,783.82 | $3,070.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.21 / $2,527.60 / $15,090.00
| Facility | | $1,189.21 | $2,527.60 | $15,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.21 / $1,783.82 / $3,070.92
| Facility | | $1,189.21 | $1,783.82 | $3,070.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,685.15 / $3,271.75 / $4,884.08
| Professional | | $2,685.15 | $3,271.75 | $4,884.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,260.32 / $17,260.32 / $17,260.32
| Facility | | $17,260.32 | $17,260.32 | $17,260.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,627.00 / $12,373.00 / $15,090.00
| Facility | | $8,627.00 | $12,373.00 | $15,090.00 |