- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.08 / $4,037.74 / $10,307.07
| Professional | | $1,331.08 | $4,037.74 | $10,307.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.16 / $2,211.19 / $3,616.69
| Facility | | $601.16 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.11 / $833.48 / $1,041.84
| Professional | | $625.11 | $833.48 | $1,041.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,000.00 / $50,000.00 / $50,000.00
| Facility | | $50,000.00 | $50,000.00 | $50,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,354.64 / $4,623.27 / $16,841.00
| Facility | | $1,354.64 | $4,623.27 | $16,841.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,903.54 / $10,913.98 / $22,478.36
| Professional | | $8,903.54 | $10,913.98 | $22,478.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $10,575.00 / $35,628.23
| Facility | | $3,600.00 | $10,575.00 | $35,628.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,903.53 / $10,913.92 / $17,232.61
| Professional | | $8,903.53 | $10,913.92 | $17,232.61 |