- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,248.07 / $10,964.78
| Facility | | $2,238.72 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $562.34 / $707.95
| Professional | | $323.59 | $562.34 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,888.44 / $12,302.69
| Facility | | $3,388.44 | $5,888.44 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $251.19 / $457.09
| Professional | | $204.17 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $16,595.87
| Facility | | $5,495.41 | $5,495.41 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $53,703.18
| Facility | | $562.34 | $562.34 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,584.89 / $1,584.89
| Professional | | $323.59 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $676.08
| Professional | | $309.03 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,128.61 / $11,481.54
| Facility | | $2,398.83 | $5,128.61 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $724.44 / $1,698.24
| Professional | | $389.05 | $724.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $457.09 / $707.95
| Professional | | $309.03 | $457.09 | $707.95 |