- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,248.07 / $14,454.40
| Facility | | $2,754.23 | $5,248.07 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $30,902.95
| Facility | | $13,803.84 | $18,620.87 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,762.47 / $12,302.69
| Facility | | $6,606.93 | $7,762.47 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $8,511.38
| Facility | | $2,187.76 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $6,456.54
| Facility | | $2,187.76 | $3,162.28 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,025.60 / $9,332.54
| Professional | | $3,311.31 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $47,863.01 / $47,863.01
| Facility | | $6,606.93 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,897.79 / $19,498.45
| Facility | | $1,995.26 | $4,897.79 | $19,498.45 |