- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,715.19 / $22,908.68
| Facility | | $4,466.84 | $10,715.19 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $28,840.32
| Facility | | $11,220.18 | $16,982.44 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $9,332.54
| Facility | | $60.26 | $100.00 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $2,884.03
| Professional | | $1,905.46 | $2,238.72 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,454.71 / $4,897.79
| Professional | | $1,862.09 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $52,480.75
| Facility | | $54.95 | $56.23 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $3,981.07
| Facility | | $2,137.96 | $2,818.38 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,165.95 / $18,620.87
| Facility | | $2,041.74 | $6,165.95 | $18,620.87 |