- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,025.60 / $16,595.87
| Facility | | $1,698.24 | $6,025.60 | $16,595.87 |
- 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 / $1,148.15 / $5,754.40
| Facility | | $66.07 | $1,148.15 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $891.25 / $1,698.24
| Facility | | $398.11 | $891.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $912.01
| Professional | | $309.03 | $501.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,023.29
| Professional | | $389.05 | $575.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $19,498.45 / $19,498.45
| Facility | | $3,715.35 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $977.24
| Facility | | $398.11 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,168.69 / $9,549.93
| Facility | | $1,819.70 | $4,168.69 | $9,549.93 |