- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,585.78 / $18,197.01
| Facility | | $2,951.21 | $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 / $4,073.80 / $10,715.19
| Facility | | $66.07 | $4,073.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,348.96 / $2,137.96
| Professional | | $446.68 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,454.71
| Professional | | $1,000.00 | $1,412.54 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $45,708.82
| Facility | | $16,595.87 | $16,595.87 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,344.23
| Facility | | $1,174.90 | $1,548.82 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $25,703.96
| Facility | | $6,760.83 | $12,302.69 | $25,703.96 |