- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,585.78 / $19,054.61
| Facility | | $3,162.28 | $7,585.78 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $15,848.93
| Facility | | $4,570.88 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,548.13 / $10,964.78
| Facility | | $66.07 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,584.89 / $2,630.27
| Facility | | $660.69 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $223.87 / $346.74
| Professional | | $117.49 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $257.04 / $501.19
| Professional | | $199.53 | $257.04 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $33,884.42
| Facility | | $7,943.28 | $7,943.28 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $489.78
| Facility | | $218.78 | $302.00 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,244.36 / $15,135.61
| Facility | | $2,951.21 | $7,244.36 | $15,135.61 |