- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,570.40 / $14,454.40
| Facility | | $1,288.25 | $2,570.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,982.44 / $29,512.09
| Facility | | $12,022.64 | $16,982.44 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,801.89 / $6,025.60
| Facility | | $3,235.94 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $7,079.46 / $13,489.63
| Facility | | $1,380.38 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $9,772.37 / $17,378.01
| Facility | | $1,380.38 | $9,772.37 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,884.03 / $4,897.79
| Professional | | $1,479.11 | $2,884.03 | $4,897.79 |
- 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 |