- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,232.93 / $23,988.33
| Facility | | $4,897.79 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,489.63 / $22,387.21
| Facility | | $7,943.28 | $13,489.63 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $8,128.31 / $19,054.61
| Facility | | $66.07 | $8,128.31 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $15,848.93 / $21,379.62
| Facility | | $1,047.13 | $15,848.93 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,548.82 / $2,089.30
| Professional | | $1,122.02 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $2,818.38
| Professional | | $1,148.15 | $1,445.44 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $33,884.42 / $63,095.73
| Facility | | $33,884.42 | $33,884.42 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,737.80 / $2,884.03
| Facility | | $1,288.25 | $1,737.80 | $2,884.03 |
- 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 |