- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,456.54 / $14,454.40
| Facility | | $2,884.03 | $6,456.54 | $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
- $8,128.31 / $9,332.54 / $15,135.61
| Facility | | $8,128.31 | $9,332.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,244.36 / $13,489.63
| Facility | | $3,162.28 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,365.16 / $7,943.28
| Facility | | $2,691.53 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $8,128.31 / $13,489.63
| Professional | | $4,168.69 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $61,659.50 / $61,659.50
| Facility | | $8,128.31 | $61,659.50 | $61,659.50 |
- 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 |