- 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
- $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
- $61.66 / $100.00 / $6,025.60
| Facility | | $61.66 | $100.00 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,148.15 / $1,513.56
| Professional | | $758.58 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $2,630.27
| Professional | | $1,047.13 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $10,000.00
| Facility | | $54.95 | $56.23 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,659.59 / $2,454.71
| Facility | | $1,288.25 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,165.95 / $18,620.87
| Facility | | $1,995.26 | $6,165.95 | $18,620.87 |