- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,000.00 / $22,908.68
| Facility | | $4,466.84 | $10,000.00 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,481.54 / $18,620.87
| Facility | | $5,370.32 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $6,025.60
| Facility | | $61.66 | $100.00 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,023.29
| Facility | | $616.60 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $1,621.81
| Professional | | $549.54 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $2,454.71
| Professional | | $1,023.29 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $10,964.78
| Facility | | $54.95 | $56.23 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,398.83
| Facility | | $1,071.52 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,495.41 / $17,378.01
| Facility | | $1,584.89 | $5,495.41 | $17,378.01 |