- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $10,232.93 / $25,703.96
| Facility | | $4,677.35 | $10,232.93 | $25,703.96 |
- 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 / $5,623.41 / $24,547.09
| Facility | | $66.07 | $5,623.41 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,022.64 / $14,791.08
| Facility | | $7,244.36 | $12,022.64 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,258.93 / $1,698.24
| Professional | | $776.25 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,412.54 / $2,691.53
| Professional | | $1,071.52 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $12,589.25 / $27,542.29
| Facility | | $2,818.38 | $12,589.25 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,659.59 / $2,691.53
| Facility | | $1,258.93 | $1,659.59 | $2,691.53 |
- 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 |