- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,905.46 / $14,454.40
| Facility | | $912.01 | $1,905.46 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,818.38 / $4,570.88
| Facility | | $2,454.71 | $2,818.38 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,905.46 / $4,168.69
| Facility | | $891.25 | $1,905.46 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,949.84 / $5,754.40
| Facility | | $912.01 | $1,949.84 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $3,235.94
| Professional | | $1,380.38 | $2,137.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,570.88 / $7,585.78
| Facility | | $2,454.71 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |