- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,456.54 / $16,982.44
| Facility | | $2,398.83 | $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 / $1,862.09 / $7,762.47
| Facility | | $66.07 | $1,862.09 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,023.29 / $2,238.72
| Facility | | $537.03 | $1,023.29 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $213.80 / $1,148.15
| Professional | | $165.96 | $213.80 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $630.96 / $1,230.27
| Professional | | $147.91 | $630.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $28,840.32 / $28,840.32
| Facility | | $4,897.79 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $346.74 / $1,071.52
| Facility | | $173.78 | $346.74 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,168.69 / $9,549.93
| Facility | | $1,778.28 | $4,168.69 | $9,549.93 |