- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $7,762.47 / $14,454.40
| Facility | | $3,467.37 | $7,762.47 | $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
- $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
- $4,073.80 / $7,413.10 / $13,489.63
| Facility | | $4,073.80 | $7,413.10 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,570.88 / $8,912.51
| Facility | | $2,691.53 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $9,772.37 / $16,218.10
| Professional | | $5,011.87 | $9,772.37 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $74,131.02 / $74,131.02
| Facility | | $9,772.37 | $74,131.02 | $74,131.02 |
- 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 |