- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,585.78 / $19,952.62
| Facility | | $2,884.03 | $7,585.78 | $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 / $3,162.28 / $9,332.54
| Facility | | $66.07 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $562.34
| Professional | | $169.82 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $741.31
| Professional | | $223.87 | $398.11 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $45,708.82 / $45,708.82
| Facility | | $11,220.18 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $338.84 / $588.84
| Facility | | $204.17 | $338.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,000.00 / $21,379.62
| Facility | | $5,623.41 | $10,000.00 | $21,379.62 |