- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,456.54 / $16,982.44
| Facility | | $2,344.23 | $6,456.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,025.60 / $13,489.63
| Facility | | $3,630.78 | $6,025.60 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,454.71 / $7,762.47
| Facility | | $66.07 | $2,454.71 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,445.44 / $1,995.26
| Facility | | $501.19 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $524.81 / $977.24
| Professional | | $234.42 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,096.48
| Professional | | $371.54 | $588.84 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $28,840.32 / $28,840.32
| Facility | | $5,754.40 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $954.99
| Facility | | $380.19 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,413.10 / $15,135.61
| Facility | | $3,801.89 | $7,413.10 | $15,135.61 |