- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $23,988.33
| Facility | | $3,548.13 | $9,549.93 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,466.84 / $12,882.50
| Facility | | $2,570.40 | $4,466.84 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $4,073.80 / $12,302.69
| Facility | | $66.07 | $4,073.80 | $12,302.69 |
- 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
- $398.11 / $501.19 / $2,818.38
| Professional | | $398.11 | $501.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,621.81 / $3,388.44
| Professional | | $389.05 | $1,621.81 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $8,912.51
| Facility | | $54.95 | $56.23 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,513.56 / $3,162.28
| Facility | | $446.68 | $1,513.56 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $10,000.00 / $20,892.96
| Facility | | $5,248.07 | $10,000.00 | $20,892.96 |