- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,365.16 / $15,488.17
| Facility | | $1,778.28 | $4,365.16 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $63,095.73 / $64,565.42
| Facility | | $46,773.51 | $63,095.73 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,819.70 / $2,187.76
| Professional | | $1,412.54 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,570.40 / $3,630.78
| Professional | | $2,041.74 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,041.74 / $3,235.94
| Facility | | $1,479.11 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $10,000.00
| Facility | | $1,380.38 | $1,995.26 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $18,197.01 / $40,738.03
| Facility | | $10,471.29 | $18,197.01 | $40,738.03 |