- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,912.51 / $22,387.21
| Facility | | $3,715.35 | $8,912.51 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,630.78 / $9,549.93
| Facility | | $66.07 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $891.25 / $1,202.26
| Professional | | $338.84 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $2,041.74
| Professional | | $724.44 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $28,840.32
| Facility | | $16,595.87 | $16,595.87 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,096.48 / $1,737.80
| Facility | | $831.76 | $1,096.48 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $25,703.96
| Facility | | $6,760.83 | $12,302.69 | $25,703.96 |