- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $22,908.68
| Facility | | $3,548.13 | $9,549.93 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $11,748.98 / $18,620.87
| Facility | | $6,918.31 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $4,677.35 / $14,125.38
| Facility | | $66.07 | $4,677.35 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $4,265.80
| Facility | | $3,630.78 | $3,630.78 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $3,630.78 / $4,365.16
| Professional | | $331.13 | $3,630.78 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $2,570.40 / $5,011.87
| Professional | | $302.00 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $16,218.10
| Facility | | $54.95 | $56.23 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $2,818.38 / $6,165.95
| Facility | | $363.08 | $2,818.38 | $6,165.95 |
- 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 |