- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $16,595.87
| Facility | | $2,290.87 | $6,165.95 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,570.40 / $8,317.64
| Facility | | $66.07 | $2,570.40 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $891.25 / $1,202.26
| Professional | | $263.03 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $891.25 / $1,621.81
| Professional | | $660.69 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $28,840.32
| Facility | | $8,912.51 | $8,912.51 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,348.96
| Facility | | $602.56 | $891.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $9,772.37
| Facility | | $2,344.23 | $4,365.16 | $9,772.37 |