- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,912.51 / $22,908.68
| Facility | | $3,548.13 | $8,912.51 | $22,908.68 |
- 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 / $2,511.89 / $10,964.78
| Facility | | $66.07 | $2,511.89 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $2,344.23
| Facility | | $707.95 | $1,047.13 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $954.99
| Professional | | $457.09 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,445.44
| Professional | | $575.44 | $724.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $33,884.42 / $33,884.42
| Facility | | $6,918.31 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | 54 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,584.89
| Facility | | $645.65 | $851.14 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,413.10 / $15,135.61
| Facility | | $3,715.35 | $7,413.10 | $15,135.61 |