- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,888.44 / $16,595.87
| Facility | | $1,659.59 | $5,888.44 | $16,595.87 |
- 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 / $2,511.89 / $5,888.44
| Facility | | $66.07 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $309.03 / $794.33
| Professional | | $204.17 | $309.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $1,023.29
| Professional | | $478.63 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $19,498.45
| Facility | | $5,248.07 | $5,248.07 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $977.24
| Facility | | $426.58 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,585.78 / $15,135.61
| Facility | | $3,890.45 | $7,585.78 | $15,135.61 |