- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,677.35 / $14,454.40
| Facility | | $2,089.30 | $4,677.35 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $27,542.29
| Facility | | $11,748.98 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,760.83 / $10,964.78
| Facility | | $5,754.40 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,918.31 / $13,489.63
| Facility | | $2,187.76 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,388.44 / $7,943.28
| Facility | | $2,137.96 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,888.44 / $9,772.37
| Professional | | $3,090.30 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $33,113.11 / $33,113.11
| Facility | | $5,888.44 | $33,113.11 | $33,113.11 |
- 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 |