- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,606.93 / $17,378.01
| Facility | | $2,511.89 | $6,606.93 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,388.44 / $8,128.31
| Facility | | $66.07 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $645.65 / $1,023.29
| Professional | | $588.84 | $645.65 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,230.27
| Professional | | $467.74 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $28,840.32 / $28,840.32
| Facility | | $7,943.28 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $660.69 / $1,023.29
| Facility | | $489.78 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $15,135.61
| Facility | | $4,265.80 | $7,585.78 | $15,135.61 |