- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,000.00 / $21,379.62
| Facility | | $3,981.07 | $10,000.00 | $21,379.62 |
- 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 / $5,370.32 / $12,302.69
| Facility | | $66.07 | $5,370.32 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $870.96
| Professional | | $389.05 | $645.65 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,202.26
| Professional | | $512.86 | $676.08 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $42,657.95
| Facility | | $7,943.28 | $7,943.28 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $1,202.26
| Facility | | $549.54 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $25,703.96
| Facility | | $6,760.83 | $12,302.69 | $25,703.96 |