- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,762.47 / $14,454.40
| Facility | | $4,786.30 | $7,762.47 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,197.01 / $29,512.09
| Facility | | $12,882.50 | $18,197.01 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,481.54 / $18,197.01
| Facility | | $9,772.37 | $11,481.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,413.10 / $13,489.63
| Facility | | $3,467.37 | $7,413.10 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,466.84 / $9,549.93
| Facility | | $2,454.71 | $4,466.84 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,549.93 / $16,218.10
| Professional | | $6,760.83 | $9,549.93 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $93,325.43 / $93,325.43
| Facility | | $9,772.37 | $93,325.43 | $93,325.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |