- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,786.30 / $14,454.40
| Facility | | $2,290.87 | $4,786.30 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,488.17 / $26,302.68
| Facility | | $11,748.98 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,918.31 / $11,220.18
| Facility | | $6,025.60 | $6,918.31 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,786.30 / $10,471.29
| Facility | | $2,290.87 | $4,786.30 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $15,135.61
| Facility | | $2,290.87 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $8,317.64
| Professional | | $3,630.78 | $5,495.41 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $30,199.52
| Facility | | $6,025.60 | $6,025.60 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |