- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $10,000.00 / $18,197.01
| Facility | | $2,290.87 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $1,621.81
| Professional | | $812.83 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,918.31 / $12,302.69
| Facility | | $3,162.28 | $6,918.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $1,380.38
| Professional | | $691.83 | $977.24 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $3,388.44
| Facility | | $812.83 | $812.83 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $954.99 / $1,862.09
| Professional | | $616.60 | $954.99 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,047.13 / $2,089.30
| Facility | | $812.83 | $1,047.13 | $2,089.30 |
- 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
- $1,995.26 / $11,220.18 / $17,378.01
| Facility | | $1,995.26 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $870.96 / $1,348.96
| Professional | | $676.08 | $870.96 | $1,348.96 |