- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $18,197.01
| Facility | | $2,454.71 | $6,760.83 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,803.84
| Facility | | $3,630.78 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,548.13 / $9,332.54
| Facility | | $66.07 | $3,548.13 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $616.60 / $831.76
| Professional | | $169.82 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,258.93
| Professional | | $501.19 | $676.08 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,840.32
| Facility | | $28,183.83 | $28,183.83 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $676.08 / $1,096.48
| Facility | | $363.08 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,000.00 / $20,892.96
| Facility | | $5,370.32 | $10,000.00 | $20,892.96 |