- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,456.54 / $16,982.44
| Facility | | $2,290.87 | $6,456.54 | $16,982.44 |
- 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 / $3,235.94 / $8,317.64
| Facility | | $66.07 | $3,235.94 | $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
- $204.17 / $416.87 / $851.14
| Professional | | $204.17 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $954.99
| Professional | | $331.13 | $524.81 | $954.99 |
- 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
- $371.54 / $549.54 / $870.96
| Facility | | $371.54 | $549.54 | $870.96 |
- 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 |