- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $10,000.00 / $18,197.01
| Facility | | $1,949.84 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $933.25 / $1,479.11
| Professional | | $676.08 | $933.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,332.54 / $17,378.01
| Facility | | $3,981.07 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $1,412.54
| Professional | | $676.08 | $794.33 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $831.76 / $1,071.52
| Facility | | $812.83 | $831.76 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,584.89
| Professional | | $724.44 | $954.99 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,737.80
| Facility | | $776.25 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,760.83 / $10,000.00
| Facility | | $1,698.24 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $1,548.82
| Professional | | $616.60 | $870.96 | $1,548.82 |