- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $10,232.93 / $21,877.62
| Facility | | $4,570.88 | $10,232.93 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,803.84 / $26,302.68
| Facility | | $8,511.38 | $13,803.84 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $6,165.95 / $22,908.68
| Facility | | $66.07 | $6,165.95 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,022.64 / $14,791.08
| Facility | | $4,265.80 | $12,022.64 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,174.90
| Professional | | $588.84 | $870.96 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,819.70
| Professional | | $741.31 | $977.24 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $50,118.72 / $50,118.72
| Facility | | $16,218.10 | $50,118.72 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,122.02 / $1,995.26
| Facility | | $870.96 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |