- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $14,454.40
| Facility | | $1,698.24 | $3,548.13 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,197.01 / $29,512.09
| Facility | | $13,803.84 | $18,197.01 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,248.07 / $8,709.64
| Facility | | $4,466.84 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,548.13 / $10,232.93
| Facility | | $1,737.80 | $3,548.13 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,981.07 / $19,952.62
| Facility | | $1,737.80 | $3,981.07 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,801.89 / $5,754.40
| Professional | | $2,454.71 | $3,801.89 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $52,480.75 / $77,624.71
| Facility | | $28,183.83 | $52,480.75 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $22,387.21
| Facility | | $8,709.64 | $16,982.44 | $22,387.21 |