- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,456.54 / $16,982.44
| Facility | | $2,454.71 | $6,456.54 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,943.28 / $15,848.93
| Facility | | $4,570.88 | $7,943.28 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,388.44 / $8,317.64
| Facility | | $66.07 | $3,388.44 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $2,398.83
| Facility | | $1,995.26 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $251.19 / $380.19
| Professional | | $204.17 | $251.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $478.63
| Professional | | $208.93 | $275.42 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $28,840.32 / $28,840.32
| Facility | | $8,912.51 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $524.81
| Facility | | $263.03 | $346.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,000.00 / $20,892.96
| Facility | | $5,370.32 | $10,000.00 | $20,892.96 |