- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.51 / $3,526.90 / $14,482.00
| Facility | | $1,579.51 | $3,526.90 | $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
- $4,419.09 / $5,164.06 / $7,921.80
| Facility | | $4,419.09 | $5,164.06 | $7,921.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.51 / $2,317.42 / $3,840.84
| Facility | | $1,579.51 | $2,317.42 | $3,840.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.51 / $2,485.86 / $6,235.00
| Facility | | $1,579.51 | $2,485.86 | $6,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.51 / $2,211.31 / $3,840.84
| Facility | | $1,579.51 | $2,211.31 | $3,840.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,608.15 / $4,396.39 / $6,562.95
| Professional | | $3,608.15 | $4,396.39 | $6,562.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,051.71 / $23,051.71 / $23,051.71
| Facility | | $23,051.71 | $23,051.71 | $23,051.71 |
- 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 |