- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,398.83 / $14,454.40
| Facility | | $1,096.48 | $2,398.83 | $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
- $3,019.95 / $3,467.37 / $5,623.41
| Facility | | $3,019.95 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $8,912.51
| Facility | | $1,071.52 | $1,445.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $14,125.38
| Facility | | $1,071.52 | $1,479.11 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,511.89 / $3,981.07
| Professional | | $1,412.54 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $27,542.29
| Facility | | $18,620.87 | $18,620.87 | $27,542.29 |
- 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 |