- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,128.61 / $10,000.00
| Facility | | $1,584.89 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $1,698.24
| Professional | | $1,000.00 | $1,318.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $33,113.11 / $69,183.10
| Facility | | $18,197.01 | $33,113.11 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $3,090.30
| Professional | | $1,513.56 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $12,022.64
| Professional | | $1,202.26 | $1,202.26 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $36,307.81 / $47,863.01
| Facility | | $10,232.93 | $36,307.81 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $3,162.28
| Professional | | $1,258.93 | $1,905.46 | $3,162.28 |