- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $17,782.79 / $17,782.79
| Facility | | $14,454.40 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $26,915.35 / $42,657.95
| Facility | | $15,848.93 | $26,915.35 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $30,199.52
| Facility | | $1,096.48 | $1,778.28 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $70.79
| Professional | | $50.12 | $58.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $33,113.11 / $38,018.94
| Facility | | $27,542.29 | $33,113.11 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $32,359.37
| Facility | | $1,023.29 | $1,698.24 | $32,359.37 |