- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,471.29 / $22,908.68
| Facility | | $4,466.84 | $10,471.29 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $13,182.57 / $22,387.21
| Facility | | $7,413.10 | $13,182.57 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $8,128.31
| Facility | | $60.26 | $100.00 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $2,089.30
| Professional | | $741.31 | $933.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $3,311.31
| Professional | | $1,513.56 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $33,113.11
| Facility | | $54.95 | $56.23 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,344.23 / $3,548.13
| Facility | | $1,698.24 | $2,344.23 | $3,548.13 |
- 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 |