- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,912.51 / $22,387.21
| Facility | | $3,548.13 | $8,912.51 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,466.84 / $12,022.64
| Facility | | $2,570.40 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,511.89 / $8,709.64
| Facility | | $66.07 | $2,511.89 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $588.84
| Professional | | $338.84 | $436.52 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $831.76
| Professional | | $354.81 | $467.74 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $33,884.42 / $33,884.42
| Facility | | $5,248.07 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $794.33
| Facility | | $380.19 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,585.78 / $15,135.61
| Facility | | $3,890.45 | $7,585.78 | $15,135.61 |