- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,912.51 / $21,379.62
| Facility | | $3,235.94 | $8,912.51 | $21,379.62 |
- 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 / $2,511.89 / $10,964.78
| Facility | | $66.07 | $2,511.89 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $446.68 / $707.95
| Professional | | $251.19 | $446.68 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $912.01
| Professional | | $316.23 | $512.86 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $33,884.42 / $33,884.42
| Facility | | $5,623.41 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $724.44
| Facility | | $302.00 | $457.09 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,365.16 / $10,000.00
| Facility | | $2,344.23 | $4,365.16 | $10,000.00 |