- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,025.60 / $16,982.44
| Facility | | $1,659.59 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,803.84
| Facility | | $3,630.78 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $100.00 / $11,481.54
| Facility | | $63.10 | $100.00 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $1,949.84
| Professional | | $181.97 | $223.87 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $977.24 / $2,290.87
| Professional | | $177.83 | $977.24 | $2,290.87 |
- 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
- $213.80 / $1,230.27 / $2,454.71
| Facility | | $213.80 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |