- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,778.28 / $14,454.40
| Facility | | $794.33 | $1,778.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,630.27 / $4,265.80
| Facility | | $2,238.72 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $3,981.07
| Facility | | $794.33 | $1,698.24 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,778.28 / $15,135.61
| Facility | | $851.14 | $1,778.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $3,311.31
| Professional | | $1,445.44 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $16,982.44
| Facility | | $11,220.18 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |