- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.02 / $4,044.60 / $14,482.00
| Facility | | $1,813.02 | $4,044.60 | $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
- $5,077.81 / $5,933.82 / $9,102.64
| Facility | | $5,077.81 | $5,933.82 | $9,102.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.02 / $2,719.53 / $4,410.00
| Facility | | $1,813.02 | $2,719.53 | $4,410.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.97 / $2,865.52 / $6,235.00
| Facility | | $1,819.97 | $2,865.52 | $6,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.02 / $2,701.40 / $4,410.00
| Facility | | $1,813.02 | $2,701.40 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,203.55 / $5,121.85 / $7,645.93
| Professional | | $4,203.55 | $5,121.85 | $7,645.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,898.52 / $26,898.52 / $26,898.52
| Facility | | $26,898.52 | $26,898.52 | $26,898.52 |
- 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 |