- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $19,952.62
| Facility | | $3,548.13 | $9,549.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,943.28 / $15,848.93
| Facility | | $4,570.88 | $7,943.28 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $4,365.16 / $12,022.64
| Facility | | $66.07 | $4,365.16 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,398.83
| Facility | | $2,041.74 | $2,041.74 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $269.15 / $407.38
| Professional | | $245.47 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $537.03
| Professional | | $218.78 | $275.42 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $33,884.42 / $33,884.42
| Facility | | $9,120.11 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $630.96
| Facility | | $263.03 | $354.81 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $16,982.44
| Facility | | $4,073.80 | $7,762.47 | $16,982.44 |