- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $9,772.37 / $21,877.62
| Facility | | $1,380.38 | $9,772.37 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $22,387.21
| Facility | | $9,120.11 | $12,882.50 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,168.69 / $6,606.93
| Facility | | $3,548.13 | $4,168.69 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,079.46 / $13,489.63
| Facility | | $1,513.56 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $9,772.37 / $17,378.01
| Facility | | $1,513.56 | $9,772.37 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,090.30 / $5,370.32
| Professional | | $1,621.81 | $3,090.30 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $27,542.29 / $27,542.29
| Facility | | $18,620.87 | $27,542.29 | $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 |