- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,786.30 / $14,454.40
| Facility | | $2,344.23 | $4,786.30 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $18,620.87
| Facility | | $6,606.93 | $10,964.78 | $18,620.87 |
- 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
- $2,570.40 / $7,244.36 / $13,489.63
| Facility | | $2,570.40 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $9,549.93
| Facility | | $2,344.23 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,248.07 / $9,120.11
| Professional | | $2,691.53 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $23,988.33 / $23,988.33
| Facility | | $6,025.60 | $23,988.33 | $23,988.33 |
- 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 |