- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $10,000.00 / $18,197.01
| Facility | | $5,011.87 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,905.46 / $3,467.37
| Professional | | $1,659.59 | $1,905.46 | $3,467.37 |
- 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
- $1,548.82 / $1,819.70 / $3,162.28
| Professional | | $1,548.82 | $1,819.70 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,454.71 / $3,801.89
| Professional | | $1,819.70 | $2,454.71 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $4,265.80
| Facility | | $1,737.80 | $2,511.89 | $4,265.80 |
- 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
- $6,309.57 / $17,378.01 / $26,302.68
| Facility | | $6,309.57 | $17,378.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,187.76 / $3,801.89
| Professional | | $1,659.59 | $2,187.76 | $3,801.89 |