- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $9,772.37
| Facility | | $1,288.25 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $851.14
| Professional | | $489.78 | $575.44 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $70,794.58 / $100,000.00
| Facility | | $46,773.51 | $70,794.58 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $21,379.62 / $45,708.82
| Facility | | $489.78 | $21,379.62 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $691.83 / $4,466.84
| Professional | | $501.19 | $691.83 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $28,183.83 / $47,863.01
| Facility | | $10,715.19 | $28,183.83 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $954.99
| Professional | | $478.63 | $660.69 | $954.99 |