- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,090.30 / $14,454.40
| Facility | | $1,778.28 | $3,090.30 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,197.01 / $28,840.32
| Facility | | $12,882.50 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $7,079.46
| Facility | | $3,801.89 | $4,466.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,918.31 / $13,489.63
| Facility | | $1,778.28 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,951.21 / $7,943.28
| Facility | | $1,698.24 | $2,951.21 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,801.89 / $6,025.60
| Professional | | $1,949.84 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $28,183.83 / $28,183.83
| Facility | | $3,801.89 | $28,183.83 | $28,183.83 |
- 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 |