- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,549.93 / $23,442.29
| Facility | | $3,715.35 | $9,549.93 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,471.29 / $17,782.79
| Facility | | $6,025.60 | $10,471.29 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,570.40 / $10,964.78
| Facility | | $66.07 | $2,570.40 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,073.80
| Facility | | $3,981.07 | $3,981.07 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $870.96 / $1,174.90
| Professional | | $426.58 | $870.96 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $891.25 / $1,698.24
| Professional | | $676.08 | $891.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $33,884.42 / $33,884.42
| Facility | | $11,748.98 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,445.44
| Facility | | $724.44 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $9,772.37
| Facility | | $2,344.23 | $4,365.16 | $9,772.37 |