- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $10,000.00 / $20,417.38
| Facility | | $1,949.84 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,949.84
| Professional | | $588.84 | $776.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $2,187.76
| Professional | | $630.96 | $912.01 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $954.99 / $2,511.89
| Facility | | $660.69 | $954.99 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,089.30 / $3,981.07
| Professional | | $1,445.44 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $3,801.89
| Professional | | $1,621.81 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $2,511.89
| Facility | | $707.95 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $977.24 / $2,187.76
| Professional | | $60.26 | $977.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,737.80 / $4,168.69
| Professional | | $616.60 | $1,737.80 | $4,168.69 |