- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,943.28 / $19,952.62
| Facility | | $3,311.31 | $7,943.28 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $15,848.93
| Facility | | $4,570.88 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,570.40 / $8,709.64
| Facility | | $66.07 | $2,570.40 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $912.01
| Professional | | $389.05 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,412.54
| Professional | | $549.54 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $45,708.82
| Facility | | $6,760.83 | $6,760.83 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,174.90
| Facility | | $537.03 | $724.44 | $1,174.90 |
- 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 |