- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,585.78 / $18,197.01
| Facility | | $3,090.30 | $7,585.78 | $18,197.01 |
- 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 / $707.95 / $8,709.64
| Facility | | $66.07 | $707.95 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $724.44 / $870.96
| Professional | | $251.19 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,479.11
| Professional | | $588.84 | $776.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $45,708.82 / $45,708.82
| Facility | | $6,760.83 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $1,047.13
| Facility | | $562.34 | $758.58 | $1,047.13 |
- 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 |