- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,248.07 / $15,135.61
| Facility | | $1,258.93 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,162.28 / $8,317.64
| Facility | | $66.07 | $3,162.28 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $3,548.13
| Facility | | $467.74 | $1,023.29 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $380.19 / $575.44
| Professional | | $354.81 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $851.14
| Professional | | $295.12 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $28,840.32
| Facility | | $10,715.19 | $10,715.19 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $1,000.00
| Facility | | $354.81 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,244.36 / $15,135.61
| Facility | | $3,090.30 | $7,244.36 | $15,135.61 |