- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,912.51 / $22,387.21
| Facility | | $3,715.35 | $8,912.51 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,471.29 / $17,782.79
| Facility | | $6,025.60 | $10,471.29 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $4,786.30 / $11,220.18
| Facility | | $66.07 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $2,089.30
| Facility | | $1,778.28 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $870.96 / $1,230.27
| Professional | | $812.83 | $870.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,513.56
| Professional | | $707.95 | $933.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $33,884.42 / $33,884.42
| Facility | | $7,943.28 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $1,905.46
| Facility | | $794.33 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,585.78 / $15,135.61
| Facility | | $3,981.07 | $7,585.78 | $15,135.61 |