- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $16,982.44
| Facility | | $2,454.71 | $6,456.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,388.44 / $9,332.54
| Facility | | $66.07 | $3,388.44 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,388.44 / $5,623.41
| Facility | | $537.03 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $912.01 / $1,230.27
| Professional | | $257.04 | $912.01 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $891.25 / $2,041.74
| Professional | | $691.83 | $891.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $28,840.32 / $28,840.32
| Facility | | $16,595.87 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,047.13 / $1,698.24
| Facility | | $758.58 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,413.10 / $15,135.61
| Facility | | $3,090.30 | $7,413.10 | $15,135.61 |