- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,912.51 / $19,952.62
| Facility | | $3,715.35 | $8,912.51 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,471.29 / $17,782.79
| Facility | | $6,025.60 | $10,471.29 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,951.21 / $10,964.78
| Facility | | $66.07 | $2,951.21 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,737.80 / $2,344.23
| Facility | | $707.95 | $1,737.80 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $1,698.24
| Professional | | $870.96 | $1,318.26 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $2,570.40
| Professional | | $1,000.00 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $33,884.42 / $33,884.42
| Facility | | $8,128.31 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,584.89 / $2,344.23
| Facility | | $1,148.15 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,413.10 / $15,135.61
| Facility | | $3,801.89 | $7,413.10 | $15,135.61 |