- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,884.03 / $14,454.40
| Facility | | $2,089.30 | $2,884.03 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,378.01 / $28,840.32
| Facility | | $12,882.50 | $17,378.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $6,918.31
| Facility | | $3,715.35 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,248.07 / $10,232.93
| Facility | | $1,548.82 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,165.95 / $16,595.87
| Facility | | $1,548.82 | $6,165.95 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,818.38 / $4,265.80
| Professional | | $1,318.26 | $2,818.38 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $63,095.73 / $63,095.73
| Facility | | $42,657.95 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $35,481.34 / $35,481.34
| Facility | | $35,481.34 | $35,481.34 | $35,481.34 |
- 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 |