- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,398.83 / $14,791.08
| Facility | | $2,290.87 | $2,398.83 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $741.31 / $1,348.96
| Professional | | $616.60 | $741.31 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,288.25 / $1,819.70
| Professional | | $630.96 | $1,288.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $2,041.74
| Professional | | $812.83 | $1,096.48 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $1,659.59
| Professional | | $741.31 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $1,905.46
| Professional | | $724.44 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $812.83
| Facility | | $501.19 | $501.19 | $812.83 |