- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $8,317.64 / $33,113.11
| Facility | | $457.09 | $8,317.64 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,982.44 / $28,840.32
| Facility | | $12,022.64 | $16,982.44 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $1,698.24
| Facility | | $912.01 | $1,071.52 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $7,244.36 / $13,489.63
| Facility | | $457.09 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $10,232.93 / $17,378.01
| Facility | | $416.87 | $10,232.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,513.56
| Professional | | $588.84 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $33,113.11 / $33,113.11
| Facility | | $22,908.68 | $33,113.11 | $33,113.11 |
- 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 |