- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $10,000.00 / $14,454.40
| Facility | | $1,905.46 | $10,000.00 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $2,570.40 / $4,786.30
| Professional | | $213.80 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $13,803.84 / $30,199.52
| Facility | | $3,162.28 | $13,803.84 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,818.38 / $5,370.32
| Facility | | $2,089.30 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,365.16 / $6,309.57
| Facility | | $2,754.23 | $4,365.16 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Professional | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $70.79
| Professional | | $32.36 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Professional | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,606.93
| Facility | | $2,884.03 | $3,801.89 | $6,606.93 |