- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,606.93 / $17,782.79
| Facility | | $2,454.71 | $6,606.93 | $17,782.79 |
- 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 / $3,235.94 / $8,317.64
| Facility | | $66.07 | $3,235.94 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,995.26 / $3,235.94
| Facility | | $630.96 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $1,174.90
| Professional | | $676.08 | $870.96 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,698.24
| Professional | | $724.44 | $891.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $28,840.32 / $28,840.32
| Facility | | $9,549.93 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $1,819.70
| Facility | | $794.33 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,549.93 / $20,892.96
| Facility | | $4,073.80 | $9,549.93 | $20,892.96 |