- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,606.93 / $16,982.44
| Facility | | $2,344.23 | $6,606.93 | $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 / $1,548.82 / $7,762.47
| Facility | | $66.07 | $1,548.82 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,023.29 / $1,659.59
| Facility | | $630.96 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $295.12 / $407.38
| Professional | | $269.15 | $295.12 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $295.12 / $691.83
| Professional | | $239.88 | $295.12 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $28,840.32
| Facility | | $4,897.79 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $398.11 / $676.08
| Facility | | $288.40 | $398.11 | $676.08 |
- 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 |