- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,456.54 / $16,982.44
| Facility | | $2,137.96 | $6,456.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,466.84 / $12,882.50
| Facility | | $2,511.89 | $4,466.84 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $239.88 / $7,762.47
| Facility | | $66.07 | $239.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $154.88 / $309.03
| Professional | | $81.28 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $407.38
| Professional | | $123.03 | $223.87 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $28,840.32 / $28,840.32
| Facility | | $1,995.26 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $190.55 / $316.23
| Facility | | $123.03 | $190.55 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,584.89 / $6,456.54
| Facility | | $588.84 | $1,584.89 | $6,456.54 |